.L 


I  )  LAs—Cs-n. 


Proceedings 


OF  THE 


FIRST  ANNUAL  MEETING 


OF  THE 


Eastern  Medical  Association, 


AT 


JNewbefsn,  J'l.  p., 


N  0  Y  K  M  IS  E  H  3rd,  1 .8  <  +  . 


DTViSK??t  CJF  HEALTH  SCIENCES  LfB&AKY 


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NEWBERN,  N.  C. 

N.  S.  RICHARDSON,  BOOK,  CARD  AND  JOB  PRINTER. 

1875. 


Hist-W  Root 

HEALTH  SCIENCES  LIBRARY 
OF  THE 

UNIVERSITY  OF  NORTH  CAROLINA 


1 

AN  8 
E13 
19Jk 
c.l 


History  Root 


Proceedings 


OF  THE 

FIRST  ANNUAL  MEETING 


OF  THE 


astern  Medical  Association 


AT 


n  JNewbern,  JN.  £., 

X  0  V  E  M  BER  3rd,  1874. 


NEWBERN,  N.  C. 

N.  S.  RICHARDSON,  BOOK  CARD  AND  JOB  PRINTER, 

1875. 


Officers  for  Ensuing  Year 


H.  O.  HYATT, . 

H.  W.  HARPER,  and  JOHN  S.  TAFT, 

P.  W.  WOOLEY, . 

J.  M.  HADLEY . 


. President, 

Vice  Presidents 

....  . |&pcj:KTAj;Y, 

. . . . :  tTreastjrer. 


JAMES  F.  LONG, 


Orator. 


PROCEEDINGS 

OF  THE  FIRST  ANNUAL  MEETING  OF  THE 

Eastern  Medical  Association, 

AT 

NEWBERN,  N.  C. 


Pursuant  to  adjournment,  the  Eastern  Medical  Association  met  in  Fire¬ 
man’s  Hall,  Tuesday  evening,  November  3d,  at  8  o’clock,  present,  Dr.  Charles 
Duffy,  Jr.,  President;  Drs.  F.  M.  Rountree,  George  L.  Kirby,  Vice  Presidents; 
Dr.  P.  W.  Wooley,  Secretary,  ad  interim. 

The  President  called  the  Association  to  order. 

The  Secretary  proceeded  to  call  the  roll,  when  the  following  members  re¬ 
sponded:  Drs.  H.  O.  Hyatt,  H.  W.  Faison,  M.  E.  Robinson,  W.  L.  Best,  S. 
S.  Satchwell,  Janies  F.  Long,  George  S.  Attmore,  C.  J.  O’Hagan,  John  S. 
Taft,  Frank  Duffy. 

Dr.  Hushes,  by  appointment  of  the  Craven  County  Medical  Association, 
delivered  the  following  address  of  welcome  in  behalf  of  the  Physicians  and 
citizens  of  Newbern  : 

Mr.  President  and  Gentlemen  of  the 

Eastern  Medical  Association : 

I  am  commissioned  by  the  Craven  County  Medical  Society  to 
bid  you  welcome  to  the  hospitalities  of  Newbern;  to  give  you  a 
cordial  greeting  and  beg  you  to  believe  that  all  we  have  is  at  your 
command  and  for  your  enjoyment.  We  congratulate  you,  tha^ 
upon  this,  your  first  annual  reunion,  your  roll  shows  constantly  in¬ 
creasing  numbers,  with  the  pleasing  assurance  that  the  beneficent 
object  of  your  Society  is  being  felt  and  appreciated  not  only  by 
members  of  the  profession,  but  also  by  the  public  at  large;  and 
that,  endearing  as  are  the  charms  of  fraternal  fellowship,  these 
are  to  be  only  secondary  to  the  free-will  offerings  to  science  and 
humanity,  which  you  assemble  here  to-night  to  make,  without 
hope  of  other  reward,  than  the  knowledge  that  “  man  in  blessing 
others,  finds  his  highest  fame.”  In  this  interchange  of  thought 
and  association,  the  profession  is  being  improved  in  moral  tone, 
ethics  and  scientific  advancement,  and  no  one  to-day  questions 


4 


Hughes’  Address  of  Welcome 


the  great  good  that  has  been  effected  by  Medical  Societies.  They 
reach  a  portion  of  the  profession,  bridge  over  a  space,  and  supply 
a  want  which  medical  journals  can  not  accomplish,  and  the  man 
is  a  sluggard  who  does  not  now  through  these  joint  agencies  keep 
pace  with  the  improvements  constantly  oceuring  in  medicine; 
yet  they  have  been  of  slow  growth  in  this  country.  From  statistics 
furnished  to  the  American  Medical  Association  in  1873,  by  that 
indefatigable  worker,  Dr.  J.  M.  Toner,  we  learn  from  the  partial 
reports  gathered  by  him,  that  there  exist  in  (he  United  States. 
408  Medical  Societies,  besides  5  National  Medical  Associations, 
and  from  this  list  are  probably  excluded  many  small  societies, 
which  were  overlooked  or  neglected  to  answer  inquires  concern¬ 
ing  their  number  and  organization,  The  first  Medical  Society 
formed  in  this  country  was  that  of  the  State  of  New  Jersey,  in 
1766;  the  second,  the  Deleware  State  Medical  Society  in  1776, 
and  the  qualification  of  membership  then,  as  in  nearly  every 
Medical  Society  since  formed,  was  the  Medical  Degree.  More 
recently,  a  number  of  societies  have  added  to  the  requirements, 
also  fealty  to  the  code  of  ethics,  moral  character  and  a  certain 
period  of  residence.  From  1776  to  1800,  nine  MedicaUHocieties 
were  formed  and  one  of  these  was  in  our  sister  State  of  South 
Carolina  in  1789.  In  the  following  ten  years,  eighteen  societies 
were  formed,  and  so  on,  slowly  till  about  1850,  when  throughout 
the  whole  country,  a  spirit  of  emulation  and  professional  zeal 
was  awakened;  the  electric  influence  of  association  was  realized, 
and  societies  sprang  up  in  all  communities,  where  the  number  of 
medical  men  was  sufficient  to  justify  a  meeting;  and  there  have 
been  organized  in  the  State  of  North  Carolina  alone,  more  socie¬ 
ties  since  the  war  than  in  the  whole  United  States  for  the  first 
thirty  years  of  our  national  existence.  The  membership  in  the 
United  States  now  numbers  twenty-three  thousand.  As  good, 
like  evil  deeds  are  never  without  their  influence,  we  see  running 
parallel  with  Medical  Societies  and  apparently  as  fruits  from  the 
seed,  the  endowment  and  organizations  of  hospitals  and  charitable 
institutions.  From  numbering  only  six  hospitals  in  the  year 
1800,  we  now  have  one  hundred  and  seventy-eight  of  these  insti¬ 
tutions,  fully  equipped,  whose  purpose  is  care  of  the  sick  and  dis¬ 
abled  ;  and  where  many  thousands,  annually  received  gratuitous 
services  and  every  comfort  necessary  for  their  sustenance  and 


Proceedings,  &c. 


5 


recovery.  Another  result  of  Medical  Societies,  is,  that,  by  the 
enlightment  of  the  public  mind,  there  are  being  formed  all  over 
the  land  in  the  larger  communities,  Boards  of  Health  ;  the  benefit 
of  whose  watchfulness  and  in  the  enforcement  of  sanitary  regula¬ 
tions,  especially  in  periods  of  epidemics,  is  almost  incalculable. — 
Your  mission  here  will  give  to  the  profession  the  experience  and 
matured  reflections,  gathered  from  the  active  life  of  the  past  year, 
and  whatever  is  for  the  good  of  our  fellow-man  will  be  given 
without  selfish  reservation  to  become  the  common  property  of  ^s 
all.  Let  us  hope  then  that  in  this  labor  for  the  amelioration  of 
the  “ills  that  flesh  is  heir  to,*’  the  advancement  of  science,  the 
honor  and  glory  of  the  profession,  you  may  find  it  agreeable  to 
partake  of  our  hospitality,  and  that  your  sojourn  among  us  may 
be  pleasant  and  always  remembered  with  kindly  emotions. — 
Again,  gentlemen,  I  bid  you  welcome. 

The  proceedings  of  the  last  meeting  were  read  by  the  Secretary,  amended 
and  approved. 

The  President  appointed  Drs.  Rountree,  Hyatt  and  Kirby  a  committee  oil 
credentials  and  the  reception  of  members,  who  subsequently  reported,  recom¬ 
mending  Drs.  C.  J.  Mattocks,  C.  G.  Cox,  H.  G.  Bates  and  G.  Slover,  candi¬ 
dates  for  membership.  Thereupon  a  vote  being  taken,  they  were  unani¬ 
mously  elected.  Drs.  Mattocks  and  Cox  signed  the  constitution  and  paid 
$1,00  each. 

On  motion  of  Dr.  Satchwell,  it  was  ordered  that  when  the  Association 
adjourns,  that  it  adjourn  to  meet  Wednesday  morning,  at  9  o’clock. 

The  Secretary  read  the  resignation  of  Dr.  N.  Herring,  of  Wilson,  which, 
on  motion,  was  accepted. 

The  Secretary  also  read  the  resignation  of  Dr.  John  G.  Rives,  of  Battleboro, 
which  was  accepted  with  an  expression  of  sympathy  for  his  affliction,  and  on 
motion  of  Dr,  Satchwell,  Dr.  J.  F.  Long  was  appointed  to  write  a  letter  ex¬ 
pressive  of  the  sympathy  of  this  body,  to  Dr.  Rives. 

The  Secretary  presented  by  request,  a  petition  in  reference  to  Medical 
Officers  in  the  Army  of  the  United  States,  which  on  motion  of  Dr.  Satchwell, 
was  referred  to  a  special  committee,  and  the  President  designated  as  said 
committee  Drs.  Satchwell,  O’Hagan  and  Faison. 

Original  papers  were  now  called  for. 

Dr.  Kirby  was  continued  to  write  a  paper  on  Quinia  and  its  substitutes. 

Dr.  Rountree  was  continued  to  write  a  paper  on  Cancer. 

Dr.  O’Hagan  was  continued  to  write  a  paper  on  Brights  disease. 

Dr.  Long  promised  to  read  a  paper  on  Cataract  during  the  meeting. 

On  motion  of  Dr.  Satchwell,  it  was  ordered  that  the  thanks  of  the  Associa' 
tion  be  tendered  to  Dr.  Hughes  for  his  admirable  welcome  address,  and  that 
he  be  requested  to  furnish  a  copy  for  publication. 


6 


Proceedings,  &c 


Wednesday  Morning,  Nov.  4tli. 

The  Association  met  according  to  adjournment,  Dr.  C.  Duffy,  Jr.,  in  the 
chair. 

Dr.  M.  W.  Harper  appeared  and  was  seated. 

The  President  announced  as  the  committee  on  nominations  for  Officers, 
Drs.  O’Hagan,  Rountree,  Hyatt,  Cox  and  Harper.  Committee  on  Finance, 
Drs.  Kirby,  Taft  and  Attmore. 

Dr.  O’Hagan  presented  a  specimen  of  Cancer  which  had  been  removed  from 
a  patient,  giving  the  history  of  the  case  and  the  (so  far)  successful  result  of 
the  operation. 

Dr.  Faison  reported  a  case  of  Spina  Bifida. 

Dr.  Satclrwell  read  an  elaborate  paper  upon  the  Hygienic  management  of 
schools,  which  was  warmly  commended  by  Dr.  O’Hagan,  and  on  motion  refer¬ 
red  to  the  committee  of  publication. 

The  rules  wrere  suspended  to  allow  Dr.  C.  Duffy  to  introduce  a  patient 
whom  he  had  treated  during  the  summer,  and  who  was  yet  under  treatment 
for  Peri -nephritic  Abscess,  complicated  with  Nephritic  Inflammation. 

The  Craven  County  Medical  Society,  through  its  Secretary,  Dr.  Attmore. 
tendered  an  invitation  to  the  members  of  this  Association  to  attend  a  banquet 
to  be  given  Wednesday  night  at  10  o’clock  at  the  Gaston  House,  which  was 
unanimously  accepted. 

Dr.  Attmore  reported  a  case  illustrating  the  effects  of  morphia,  hypodermi¬ 
cally  introduced,  in  cases  of  threatened  abortion. 

Dr.  Attmore,  extended  his  remarks,  insisting  upon  the  position  lie  first  as¬ 
sumed. 

Dr.  Charles  Duffy  introduced  a  patient  (a  negro  woman)  with  Elephantiasis 
of  both  feet  and  legs;  but  who  is  not  under  his  treatment. 

Dr.  J.  F.  Long  read  a  paper  on  the  progress  of  medicine  and  the  collateral 
sciences;  and  designating  particularly,  as  the  subject  of  his  paper,  Hydrate  of 
Chloral,  or  Chloral  Hydrate,  its  history,  chemical  composition,  and  therapeuti¬ 
cal  effects;  especially  in  labor  and  puerperal  eclampsia. 

Dr.  Kirby  agreed  in  the  main  with  the  conclusion  of  Dr.  Long,  but  he  had 
seen  a  fatal  result  from  the  administration  of  a  combination  of  10  grs.  of 
chloral  and  20  grs.  bromide  of  potassium,  two  doses  of  which  were  given  to  a 
woman  in  the  puerperal  state,  attacked  with  typhoid  fever;  and  attributed 
death  to  paralysis  of  the  heart . 

Dr.  O’Hagan  would  hardly  attribute  their  fatal  result  in  this  case  to  the 
effects  of  the  chloral,  and  was  confident  that  the  bromide  of  potassium  had  no 
agency  in  the  result. 

Dr.  Faison  thought  that  by  the  combination,  Dr.  Kirby  had  administered 
chloroform  instead  of  chloral. 

Dr.  Long  admitted  that  this  result  followed  the  combination. 

Dr.  Kirby  inquired  if  the  conversion  took  place  as  soon  as  combined  and 
before  administration  ? 

Dr.  Long  answered  affirmatively. 


Proceedings,  &c. 


t+J 

( 


Dr.  Kirby  had  only  mentioned  his  case  that  he  might  interpose  a  word  of 
caution  in  the  indiscriminate  use  of  the  medicine. 

Dr.  O’Hagan  thought  that  Dr.  Kirby  had  reasoned  from  a  part  of  the  whole. 
A  single  case  amounted  to  little.  Any  narcotic,  or  even  hypnotic  might  have 
produced  the  same  effect.  Under  certain  circumstances  he  had  seen  the  best 
effects  from  chloral  in  typhoid  fever.  In  the  case  as  described  by  Dr.  Kirby, 
he  would  have  administered  a  stimulus. 

Dr.  Frank  Duffy  thought  it  was  generally  conceded  that  chloral  was  con¬ 
traindicated  in  intestinal  lesions,  and  weakness  of  the  heart’s  motion. 

On  motion  of  Dr.  Satchwell,  the  Association  adjourned  until  2^  o’clock  p.  m. 


Afteenoon  Session. 

The  Association  met  pursuant  to  adjournment,  Dr.  Duffy  in  the  chair. 

The  Committiee  on  Nominations  made  a  report,  recommending  the  follow¬ 
ing  officers  for  the  ensuing  year  : 

For  President — H.  0.  Hyatt. 

For  Secretary — P.  W.  Wooley. 

For  Treasurer — J.  M.  Hadley. 

For  Orator—  James  F.  Long. 

For  Vice  Presidenst — M.  W.  Harper  and  John  S.  Taft. 

Dr.  Attmore  proceeded  to  read  a  paper  on  Aural  Catarrh.  (See  Appendix 
C.) 

Ou  motion  of  Dr.  Kirby,  Dr.  Attmore’s  paper  was  referred  to  the  committee 
of  publication. 

Dr.  Frank  Duffy  read  a  paper  on  Individual  Physiology,  or  the  science  of 
individuality.  [See  Appendix  D. ) 

On  motion  of  Dr.  Satchwell,  it  was  referred  to  the  committee  of  publication. 

Call  foe  Oeal  Communications. 

Dr.  Long  addressed  the  Society  for  about  an  hour  on  Heredity,  in  its  rela¬ 
tion  to  the  increase  of  mental,  moral  and  physical  diseases,  and  the  urgent  ne¬ 
cessity  of  legislative  action  in  additional  restrictions  to  liberty  of  marriage. 

On  motion  of  Dr.  Frank  Duffy,  Dr.  Long  was  requested  to  publish  his  ad¬ 
dress. 

Dr.  Kirby  moved  to  suspend  the  rules  in  order  to  take  up  the  subject  of 
localizing  the  meetings  of  this  Association.  Withdrawn  for  the  present. 

The  Committee  on  candidates  for  membership  recommended  Dr.  C.  C.  Duffy. 
Report  of  the  committee  received  and  adopted,  and  the  committee  discharged. 

Dr.  Kirby’s  motion  to  localize  the  meetings  of  the  Association  again  came 
up.  Dr.  Kirby  moved  to  adopt. 

The  adoption  of  the  resolution  was  advocated  by  Drs.  Attmore,  Faison  and 
Kirby,  and  opposed  by  Drs.  O’Hagan  and  Satchwell. 

Dr.  Taft  moved  to  lay  on  the  table 

Dr.  Kirby  moved  to  amend  the  resolution  by  proposing  to  have  the  Annual 


8 


Satch well’s  Executive  Report 


meeting  at  Goldsboro  permanently  in  the  Fall,  and  the  other  meetings 
wherever  the  Association  may  select.  Lost. 

Motion  to  lay  on  the  table  prevailed. 

Goldsboro  was  selected  as  the  place,  and  the  first  Tuesday  in  February,  at 
3  o’clock  P.  M.,  as  the  time  of  the  next  meeting  of  this  Association, 

An  invitation  to  attend  the  Ball  of  the  Elm  City  Base  Ball  Club  was  tender¬ 
ed,  for  which  the  Association  returned  thanks  and  accepted. 

Adjourned  until  1\  o’clock. 

The  committee  on  constitution  and  by-laws  asked  and  obtained  further  time 
to  make  a  report. 

The  committee  to  whom  was  referred  the  petition  in  reference  to  the  grade 
of  medical  officers  in  the  United  States  Army,  through  their  chairman,  Dr. 
O’Hagan,  submitted  a  report  in  which  they  recommended  that  every  member 
sign  the  petition,  and  that  a  resolution  is  unnecssary. 

The  committee  on  Finance  made  a  report,  that  in  the  absence  of  the  Treas¬ 
urer  no  accurate  statement  can  be  made;  but  there  are  out-standing  claims 
against  the  Association,  and  recommend  an  assessment,  of  $1.00  for  each 
member. 

Dr.  Hyatt  was  duly  installed  President  of  the  Association,  and  returned 
thanks  for  the  honor  conferred  in  a  brief  and  appropriate  address. 

Dr.  Duffy,  the  retiring  President,  then  delivered  an  interesting  valedictory, 
which, 

On  motion  of  Dr.  Long  was  referred  to  the  committee  of  publication.  (See 
Appendix  A. ) 

Dr.  Satchwell,  Chairman  of  the  Executive  Committee,  then  proceeded  to 
read  the  following  report  : 

Mr.  President  and  Felloiv  Members  of  the 

Eastern  Medical  Association : 

Onr  constitution  imposes  upon  your  Executive  Committee  the 
important  duty  of  “  looking  after  the  interest  of  the  Association 
in  the  interim  of  its  meetings,  to  have  due  regard  to  the  status  of 
members,  to  make  recommendations  for  the  good  of  the  Associa¬ 
tion,  and  for  the  improvement  of  the  profession.”  It  need 
scarcely  be  said,  therefore,  that  our  Association  was  formed  from 
an  acknowledged  necessity  of  giving  a  new  impetus  to  the  cause 
of  Medical  progress,  especially  in  Eastern  North  Carolina.  Its 
existence  implies  the  great  need,  especially  since  the  late  war,  of 
medical  improvememt  and  reform.  The  movement  which  has 
already  rallied  so  many  of  our  worthiest  and  most  prominent 
physicians  into  the  ranks  of  its  membership,  is  an  avowal  that 
the  former  brightness  of  the  escutcheon  of  the  profession  has  been 
sadly  tarnished. 


Satchwell’s  Executive  Report. 


9 


We  lutve  banded  together  to  redeem  our  calling  from  its  low 
estate,  and  to  make  war  upon  that  preverbial  disregard  of  the 
Code  of  Ethics,  and  that  growing  looseness  of  construction  of  its 
provisions  and  requirements  which  drags  the  profession  down  to 
a  level  with  the  trades,  and  makes  us  blush  at  the  sweeping  in¬ 
roads  upon  its  honor.  If  any  member  hesitates  to  engage  in  this 
labor  of  love  for  the  resuscitation  and  redemption  of  his  profes¬ 
sion,  the  Eastern  Medical  Association,  with  its  elevated  platform 
of  principles,  offers  him  no  congeniality,  and  this  is  not  the  place 
for  him. 

So  far  as  the  record  of  the  Chairman  of  this  Committee  relates 
to  this  matter — if  you  will  pardon  the  allusion  to  himself — it  has 
been  over  twenty  years  since  he  first  unsheathed  his  maiden  sword 
in  the  war  for  Medical  improvement  and  reform  in  North  Caro¬ 
lina.  This  is  about  co-eval  with  the  existence  of  our  parent 
State  Medical  Society  to  which  our  Association  is  auxiliary  and 
co-operative.  From  those  earliest  days  of  his  Medical  life  until 
now,  in  season  and  out  of  season,  under  all  the  changing  condi¬ 
tions  and  circumstances  of  war  and  of  peace,  of  prosperity  and 
adversity — amid  all  the  chequered  scenes,  mighty  events,  and 
thrilling  memories  which  pertain  to  our  impoverished  people  and 
desolated  section,  he  has,  by  example  and  precept,  stood  boldly  and 
faithfully  for  a  strict  construction  of  the  Code  and  for  the  honor 
and  elevation  of  the  profession.  True,  this  uncompromising  de¬ 
termination  from  first  to  last  to  work  for  the  professional 
interests  of  the  State  has  encountered  the  opposition  of  the  loose 
constructionists  everywhere.  The  readiness  of  so  many  of  them 
to  sacrifice  principle  and  duty  upon  the  lower  shrine  of  expedi¬ 
ency,  selfishness,  and  money-making,  has  subjected  your  Chair¬ 
man,  as  others,  to  such  a  constant  course  of  misrepresentation  and 
abuse,  that  he  has  lost  many  a  dollar  and  the  applause  of  the 
fickle  multitude  for  refusing  to  abandon  principle  and  professional 
devotion  so  constantly  puffed,  and  yet  so  cordially  dispised  by 
the  swarms  of  Medical  tricksters  and  demagogues  now  more  than 
ever,  abounding  in  this,  as  well  as  in  all  the  Southern  States.  It 
is  no  less  astonishing  than  lamentable  to  see  so  many  of  our 
Medical  brethren  who  occupy  places  in  the  front  ranks  of  the 
profession,  guilty,  both  by  omission  and  commission,  of  a  loose 
construction  of  our  Code  by  precept  and  example,  and  ready  to 


10 


Satciiwell’s  Executive  Report. 


excuse  and  paliate  its  palpable  violations  by  others,  and  even 
opposed  to  the  discipline  and  punishment  of  Medical  criminals  in 
our  regular  ranks  who  have  forfeited  every  claim  to  the  courtesies 
and  consultations  of  the  profession.  Your  Chairman  has  seen 
this  and  so  much  of  such  as  this,  especially  sine  *  the  war,  in 
North  Carolina,  that  he  is  prepared  to  say  that  his  words,  uttered 
in  advocacy  of  the  union,  organization,  and  elevation  of  the  pro¬ 
fession,  have  fallen,  as  this  paper  may  fall,  dull,  cold,  and  dis¬ 
heartening;  to  be  disregarded  and  forgotten  like  the  idle  wind 
that  passes.  But  what  if  ingratitude  and  inappreciation  should 
so  much  abound  ?  What  if  those  of  us  who  have  so  long  and 
truly  battled  for  the  rights  and  organization  of  the  profession 
should  continue  to  be  denounced  for  it  as  we  have  all  along  been 
by  demagogues  within  and  without  the  profession?  What  if 
this  whole  tribe  do  say  that  our  motive  in  this  work  of  science 
and  self-sacrilice  is  to  advance  the  price  of  medical  service  at  the 
expense  and  injury  of  the  people?  What  matters  it  to  the  true 
reformer  and  the  unflinching  advocate  of  the  rights  and  duties  of 
his  profession  and  of  his  race  if  he  does  continue  to  be  vilified  and 
badly  treated,  even  after  the  truths  he  has  contended  for  are  dis- 
pised  by  some,  disregarded  by  others,  and  so  often  forgotten  by 
the  many?  To  go  onward  still  in  disregard  of  these  denuncia¬ 
tions  and  to  persevere  and  continue  to  work  amid  the  proverbial 
demoralizations  now  more  than  ever  abounding  in  our  own  and 
other  professions,  is  the  stern,  uncompromising  duty  of  every 
member  of  our  profession  who  has  the  grit  of  true  manhood  and 
is  animated  by  that  heroic  faith  and  love  for  the  science  and 
practice  which,  in  the  telling  events,  changes  of  society,  and 
whirl  of  revolution  pecular  to  this  extraordinary  age,  still  makes 
our  calling  honorable  and  glorious. 

The  demagogueism,  meanness,  and  depravity  daily  exhibited 
by  so  many  around  us,  and  most  of  them  holding  authority  to 
practic  Medicine  and  Surgery  from  recognized  Medical  Colleges, 
were  prominent  in  the  impelling  motives  of  those  who  formed 
this  Association.  The  imperfections,  demoralizations,  and  down¬ 
ward  tendencies  of  the  profession  at  this  very  hour  in  North 
Carolina,  are  so  many  warning  notes  and  bugle-blast  appeals  to 
our  true  hearted  brethern  to  come  to  the  rescue  that  we  may 
save  our  calling  from  these  and  other  lowering  and  destructive 


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11 


influences  so  alarmingly  prevalent.  It  is  an  established  doctrine 
of  moral  science  that,  to  sit  in  silence  and  with  folded  arms  while 
vice  and  crime  stalk  menacingly  around,  is  but  little  else  than 
encouragement  to  the  same,  and  is  almost  in  fact  a  participation. 
So  likewise  should  we  consider  the  high  duties  devolving  upon 
us  in  our  cherished  pursuits — that  if  we  do  not  oppose  and  de¬ 
nounce  crimnal  violations  of  our  Code — if  we  extend  courtesies 
and  consultations  to  regular  members  of  the  profession  who  are- 
steeped  in  the  various  arts  and  wiles  of  the  medical  deceirer  and 
trickster, — that  evidence,  incontrovertable,  stains  their  garments 
with  personal  dishonor  and  flagrant  professional  derelictions, 
then  are  we  ourselves  guilty  of  wrong  doing  to  our  profession  and 
to  others  who,  because  of  the  inexcusable  conduct  of  such  male¬ 
factors,  withhold  from  them  recognition  and  consultation.  If 
the  principle  thus  enunciated  is  not  sound,  practical,  and  worthy 
of  being  incorporated  into  our  governing  motives  as  well  as  into 
the  organice  laws  of  the  Eastern  Medical  Association,  as  it  is 
surely  enforced  by  the  general  drift  and  spirit  of  our  Code,  then 
will  demagogues  and  offenders  always  go  free  and  unpunished, 
and  we  are  grossly  defective  in  our  medical  organizations,  as  we 
are  greatly  crippled  in  our  efforts  for  good. 

Reform  on  this  question  is  imperatively  demanded.  There 
must  be  more  elevation,  as  well  as  concert  of  action  and  union 
of  sentiment  among  us  all  on  this  vital  principle  of  medical 
duty  as  relating  to  these  criminal  violations  by  those  who  in 
grossly  offending  against  one  or  more  should  be  regarded  as 
equally  a  criminal  offender  against  the  whole.  The  contest  for 
practice  has  become  so  great,  in  the  higher  as  well  as  lower 
grades  of  practitioners,  that  expediency  and  abandonment  of  the 
obligations  of  ethics  and  duty  to  the  neglect  and  sacrifice  of 
principle,  now  rule,  and  hence  the  looseness  of  construction  of 
our  organic  laws  of  conduct  and  the  consequent  injury  to  the 
profession.  How  often  do  we  hear  some  brother  practitioner  say 
that  “even  if  Doctor  A.  did  act  dishonorable  towards  Doctor  B. 
— did  trample  under  his  feet  the  Code  and  all  honor  and  plighted 
faith — he  has  always  acted  well  towards  me,  and  I  shall  therefore 
stand  by  him  and  consult  with  him,  let  others  say  and  prove 
what  they  please.” 

Gentlemen,  the  utterance  and  practice  of  such  a  doctrine — as 


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so  many  of  our  boasted  regulars  are  doing — so  inconsistent,  as  it 
is,  with  sound  morals  and  true  professional  devotion  :  and  all  based 
upon  the  unworthy  motive,  nine  times  out  of  ten  of  gaining  popu- 
ularity  and  making  money,  is  a  palpable  departure  from  the  line 
of  duty  and  professional  obligation,  and  at  variance  with  the 
humane  purposes  and  noble  objects  of  this  and  kindred  associa¬ 
tions.  Such  motives  and  conduct  should,  in  every  honorable  and 
legitimate  way,  be  discountenanced  and  put  down  by  all  who 
would  avert  those  professional  discouragements  and  evils  which, 
more  than  ever,  have  perverted  and  prostituted  the  profession  in 
North  Carolina.  If  the  profession  in  Eastern  North  Carolina 
has  come  to  this,  and  such  as  this — evident  to  all,  too,  that  it  has 
thus  retrograded — it  can  excite  no  surprise  that  so  many  of  our 
ablest,  best,  and  purest  are  leaving  its  ranks.  So  long  as  accept¬ 
ed  exemplars  of  the  Code  and  leaders  of  the  profession,  thus 
tolerate  its  violation  and  excuse  the  unprofessional  conduct  of 
this  increasing  class  of  demagogues  and  medical  whipper-snappers 
in  our  regular  ranks,  just  so  long  are  these  high  authorities  giving 
encouragement  and  endorsement  to  this  unworthy  class.  It  is 
thus  the  profession  is  assailed  in  vital  points  by  those  who  claim 
to  be  high-churchmen  in  medicine,  and  thus  are  blows  continually 
given  to  the  cause  of  medical  improvement  and  elevation.  The 
sooner  we  admit  and  act  upon  this  disheartening  and  painful 
truth,  the  better  it  will  be  for  the  credit  of  ourselves  and  the  salva¬ 
tion  of  our  prostrate  profession.  We  are  constantly  talking  ethics, 
but  how  few  of  us  observe  the  Code!  The  wants  and  necessities 
upon  most  of  us  in  these  poverty-stricken  times  are  stringent  and 
trying  to  our  metal,  it  is  true.  But  we  are  bound  to  put  our  faces 
against  the  fashionable  custom  which  allows  the  unrighteous  god 
of  mammon,  or  an  unscrupulous  ambition  for  success,  to  sweep 
away  the  cherished  landmarks  of  principle  that  make  up  the 
fabric  upon  which  rests  the  profession. 

Nor  is  the  outlook  less  gloomy  in  this  scramble  for  practice, 
when  we  contemplate  the  conduct  of  so  many  in  disregarding 
their  plighted  faith  as  to  a  schedule  of  prices  for  mileage  and 
medical  service.  While  the  public  appreciate  medical  skill,  that 
appreciation  is  sadly  defective  when  our  bills  are  presented  for 
payment.  It  is  then  that  evidence  piles  upon  evidence  of  the 
public  conclusion  that  physicians  are  able  to  live  on  air  and 


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13 


water,  and  ought  to  do  so.  The  practitioner  who  ministers  to 
this  inappreciation  of  medical  talent  and  service,  as  numbers  of 
our  regular  brethren  do  daily  around  us,  commits  an  inexcusable 
wrong  to  himself,  his  rivals  for  practice,  and  to  his  profession  at 
large.  That  important  feature  of  our  Code,  which  renders  it  the 
duty  of  the  physicians  of  every  community  to  unite  in  the  adop¬ 
tion  and  observance  of  a  uniform  system  of  charges,  and  that  it 
should  be  deemed  a  point  of  honor  to  adhere  to  them  with  con- 
ciencious  uniformity,  is  a  wise  and  conservative  principle,  neces¬ 
sary  and  even  indispensable  to  the  subsistence  and  healthy  exist¬ 
ence  of  the  profession  ;  and  yet  this  preservative  feature,  which 
all  ought  to  regard  with  unflinching  loyalty,  has  become  almost 
a  mockery  amid  the  professional  derelictions  and  grovelling 
tendencies  of  the  times.  On  this  paramount  question  of  subsis¬ 
tence,  based  as  in  this  case  upon  the  integrity  and  honor  of  those 
practitioners  around  us  who  have  a  high  duty  in  this  relation  to 
perform, — involving  as  it  does  life-blood  to  us  all,  there  is  a  pre¬ 
vailing  selfishness,  disregard  of  principle,  and  degeneracy  of 
sentiment  and  action,  which  has  dragged,  and  is  dragging  down 
the  profession  to  the  level  of  the  trades.  The  struggle  for  prac¬ 
tice  has  become  so  unworthy,  and  the  views  of  professional  duty 
and  obligation  so  selfish  and  demoralized,  that  each  charges  as  he 
pleases  without  regard  to  the  rights  of  others,  or  the  welfare  and 
dignity  of  our  common  calling.  Plighted  faith,  a  common 
agreement,  to  abide  by  a  tariff  of  charges  formed  by  all,  as  our 
organic  laws  demand,  is  only  made  to  be  broken.  He  gets  who 
caR,  whether  he  treads  or  not  upon  the  toes  of  neighboring  rivals 
for  the  practice  and  honors  of  the  profession.  Its  dignity  is  un¬ 
ceremoniously  bartered  away,  its  traditionary  rights  and  duties 
disregarded  with  impunity,  and  medical  science,  with  all  its  hal¬ 
lowed  associations,  is  now  put  upon  the  market  and  sold  as  the 
shop  keeper  sells  his  goods  or  the  butcher  sells  his  meat. 

In  this  waste-howling  wilderness  of  medical  depravity,  there 
are  a  few  portions  of  our  State  that  are  exceptional,  and  some  of 
our  brethren  whose  garments  are  unsoiled,  and  whose  honor  is 
unsullied,  amid  the  general  decay  of  morals  and  of  lowering  pro¬ 
fessional  tendencies.  It  is  consoling  to  know  that  44  Rome  hath 
not  lost  its  blood  of  noble  men  ”  amid  the  consuming  work  of 
the  heretics  and  of  the  “  Goths  and  Vandals”  within  and  without 


L4 


Satchwell’s  Executive  Report. 


the  regular  pale,  who,  in  reinforcing  the  various  grades  of  delin¬ 
quents,  and  malefactors,  have  so  grievously  degraded  and  dis¬ 
graced  the  profession. 

It  is  a  humiliating  acknowledgment,  that  the  physician  who 
is  the  most  cunning,  or  crafty,  or  successful  in  trading  away  his 
calling — selling  it  may  be  his  medical  “birthright  for  a  mess  of 
pottage,”  is  regarded  by  the  public,  so  incompetent,  it  must  be 
admitted,  to  judge  correctly  of  the  skill  or  merits  of  physicians, 
as  the  smartest  and  most  deserving;  while  the  physkdan,  who, 
in  being  satisfied  with  a  moderate  compensation,  is  as  much  op¬ 
posed  to  overcharging  as  to  unjustifiable  undercharging,  stands 
by  principle  and  the  rights  of  his  profession  at  whatever  sacrifice, 
is  thought  by  the  unthinking  multitude  to  be  wanting  in  com¬ 
mon  sense,  and  derelict  in  duty  to  himself  and  family.  The  dis¬ 
position  of  such  a  large  number  of  practitioners  in  North  Caro¬ 
lina  to  allow  their  patients  to  determine  the  amount  of  their 
professional  accounts,  instead  of  deciding  the  amount  for  them¬ 
selves  upon  the  principles  of  justice  and  integrity,  is  not  alone 
conclusive  evidence  generally  of  mental  weakness  and  profession¬ 
al  incompetency,  but  has  been  highly  instrumental  in  reducing 
our  cherished  calling  to  this  level  with  the  trades  and  its  existing 
condition  of  reproach  and  poverty.  True,  the  poverty  of  our 
people,  as  resulting  from  the  war,  and  much  aggravated  by  op¬ 
pressive  laws,  such  as  have  been  so  often  the  inheritance  of  the 
vanquished,  however  just  and  noble  their  cause,  has  rendered 
them  unable  to  pay  large  medical  fees,  and  our  profession,  with 
its  characteristic  liberality  and  humanity,  wisely  recognizes  this 
common  misfortune.  But,  after  every  reasonable  and  human 
allowance  in  this  relation,  the  public  still  cling  pertinaciously  to 
the  hereditary  error  that  doctors  can  live  without  money,  and  can 
clothe,  and  feed,  and  educate  their  children  without  price,  so  long 
as  flattery  and  false  promises  of  patients  are  so  cheap,  and  the 
Homestead  shields  rogues  and  thieves.  In  the  race  of  competion 
for  practice  these  hard  times,  when  bad  faith,  want  of  principle, 
and  dishonorable  rivalry,  within  as  well  as  without  the  profession, 
have  more  than  ever  corrupted  the  morals,  seared  the  conscience, 
and  lowered  the  standard  of  the  profession,  most  of  us  have  be¬ 
come  so  impoverished  and  dependant,  that  it  requires  a  stout  heart 
and  a  determined  will  not  to  be  of  that  large  class,  who  are  vir- 


Satchwell’s  Executive  Report. 


15 


tually  u  hewers  of  wood  and  drawers  of  water”  for  an  ungrateful 
and  inappreciative  public.  Especially  has  the  combination  of 
circumstances  and  influences,  as  herein  indicated,  dragged  down 
the  profession  to  a  low  and  mortifying  level  in  our  fields  of  coun¬ 
try  practice.  It  is  in  the  rural  sections,  more  than  in  our  towns 
and  cities,  that  the  medical  demagogue  and  imposter  finds  a  con¬ 
genial  theatre  upon  which  he  luxuriates  and  fattens  by  his 
incompetency  and  meanness.  It  is  here  that  the  devotion  to 
principle  and  high-toned  bearing  of  the  studious  and  skillful  phy- 
sian  finds  the  greatest  contrast  with  the  low  impulses  and  un¬ 
scrupulous  conduct  of  shallow-headed  rivals  who  spend  their  time 
so  profusely  in  humbugging  and  imposing  upon  credulous  and 
ignorant  communities.  Unless  improvement  in  these  relations 
soon  begins  to  brighten  the  escutcheon  of  the  profession — unless 
there  is  more  uniformity  of  charges,  and  more  remunerative  com¬ 
pensative  for  medical  service,  the  disgraceful  scramble  for  practice 
now  going  on  in  every  county  in  North  Carolina,  will  drive  a 
much  larger  number  still  of  the  true  medical  gentlemen  of  the 
State  from  our  ranks,  to  seek  a  more  remunerative  and  appreciative 
field  of  labor  in  other  departments  of  life.  The  increasing 
swarms  of  devowering  empirics  and  imposters  who  infest  society 
and  obstruct  the  paths  of  medical  progress,  will  not  decrease 
until  popular  intelligence  has  banished  much  of  that  ignorance 
and  prejudice  now  so  rampant  and  effective  in  sapping  the  foun¬ 
dations  of  a  healthy  public  sentiment.  The  times  in  which  we 
live,  circumstances  and  results  connected  with  the  late  war,  sug¬ 
gest  an  expression  of  these  views.  It  is  well  for  us  to  heed  them. 
The  first  step  towards  the  correction  of  an  error  or  the  removal 
of  an  evil  is  a  frank  acknowledgment  of  its  existence;  the  best 
way  to  avoid  danger  is  to  look  it  plump  in  the  face.  This  ques¬ 
tion  of  subsistence  by  practice  is  one  so  direct  and  vital  that  we 
cannot  escape  from  it.  He  who  regards  it  from  a  stand  point  of 
timidity,  fear  of  unpopularity,  or  time-serving  views  of  policy,  is 
wanting  in  fidelity  to  himself  and  profession. 

Let  us  not  hesitate  to  inculcate  and  insist  upon  union  of  the 
profession  in  every  community  as  to  a  tariff  of  charges.  It  is  the 
duty  of  this  Association  to  take  a  just  and  bold  stand  upon  this 
question,  and  to  engage  in  some  legislation  that  will  end  in 
practical  and  efficient  results  in  this  very  important  relation.  Give 


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Satchwell’s  Executive  Report 


a  cold  shoulder  to  that  neighboring  practitioner  who  refuses  to 
come  into  and  abide  by  a  reasonable  agreement  to  that  end. — 
Draw  off  still  farther  from  him  who,  having  voluntarily  made 
such  an  agreement,,  purposely  disregards  the  same.  Brand  with 
contempt  and  expulsion  that  neighboring  medical  rival  who  is 
a  traitor  to  duty,  to  his  pledges,  and  to  his  brethren,  to  the  extent 
of  assailing  these  necessary  regulations,  and  of  thus  ignomini- 
ously  and  meanly  attacking  others  in  such  low  efforts  to  obtain 
practice  and  popular  sympathy.  Do  not  disappoint  the  just 
expectations  of  our  brethren  who  are  watching  our  movements, 
nor  fail  to  redeem  our  promises  by  refusing  to  come  up  to  our 
measure  of  duty  on  this  subject,  by  taking  grounds  which,  while 
humane  and  tenable,  are  manly,  elevated,  and  just  to  ourselves 
and  the  public.  Your  Committee  would  be  remiss  in  duty  not 
to  have  invited  your  serious  attention  to  the  general  and  lament¬ 
able  inability  cf  physicians  to  collect  their  fees,  especially  in  our 
sparcely  settled  rural  sections.  That  reform  is  imperatively  de¬ 
manded  in  this  matter  of  life-blood — of  just  remuneration  for 
professional  services, — is  so  evident  to  all,  that  to  state  the  fact  is 
but  to  prove  it.  “  We  cannot  collect  oar  Bills  ”  is  more  than  ever 
the  universal,  depressing,  and  almost  despairing,  cry  of  country 
physicians.  This  complaint  not  only  comes  in  part  from  the 
“hard  times”  now  so  pinching  to  all  classes  and  occupations, 
but  it  is  based  mainly  upon  the  depravity  of  the  times,  as  con¬ 
nected  with  the  proverbial  ingratitute  of  the  public  to  physicians 
for  services  rendered,  and  the  well-known  disposition  of  a  very 
large  number  of  patients  not  to  pay  the  doctor.  This  inability 
since  the  war,  of  physicians  to  collect  bills,  does  not  originate 
from  financial  inability  of  our  patients  to  pay,  poor  though  so 
many  of  them  are,  but  it  arises  from  the  prevailing  demoraliza¬ 
tion  in  regard  to  obligations  to  pay  just  debts,  and  to  the  advan¬ 
tages  which  so  many  mean  men  take  of  the  shield  of  the  Home¬ 
stead  Exemption  law.  Herein  exists  additional  demaud  for  the 
union  of  the  profession  everywhere,  in  order  that,  while  doing 
justice  to  our  patients,  we  may  receive  justice,  and  ourselves  and 
families  saved  from  extreme  want  and  poverty.  The  operation 
of  causes  thus  alluded  to,  has  entailed,  and  is  entailing  upon  the 
profession,  an  overwhelming  load  of  poverty,  with  its  attendant 
anxiety  and  distress. 


Satch  well's  Executive  Report 


17 


The  picture  presented  is  correct,  except  that  it  is  not  lull 
enough.  The  sad  condition  on  these  vital  points,  presents  an  in¬ 
exorable  demand  for  improvement  and  reform.  With  the  broad 
fact  staring  us  in  the  face,  that  swindlers  and  dishonest  debtors 
prey  and  impose  upon  our  liberal  and  humane  profession  far  more 
than  upon  any  other  class  or  calling,  it  is  our  high  duty  to  appeal 
to  our  brethren  in  every  section  of  North  Carolina  to  arouse  from 
their  lethargy,  and  meet  the  emergencies  now  upon  us.  To  hesi¬ 
tate  is  to  doom  the  profession  to  a  still  sadder  fate,  and  to  drive  a 
yet  larger  number  of  our  brightest  minds  and  noblest  members 
to  other  pursuits  for  a  living. 

It  is  a  painful  sense  of  duty  which  compels  your  Committee  to 
call  your  attention  to  the  growing  disregard  by  the  profession  of 
the  State  of  the  requirements  of  Sections  3rd  and  4th,  Article 
1st,  chapter  2nd,  of  our  Code  of  Ethics.  It  is  denounced  herein 
as  “  derogatory  to  the  dignity  of  the  profession  to  publish  cases 
and  operations  in  the  daily  prints,  or  suffer  such  publications  to 
be  made,”  “  to  boast  of  cures  or  remedies,”  “  to  adduce  certificates 
of  skill  and  success,  or  to  perform  any  other  similar  acts.  These 
are  the  ordinary  practices  of  empirics,  and  are  highly  reprehensi¬ 
ble  in  a  regular  physician.”  And  yet  you  can  take  up  almost 
any  newspaper  of  any  date  and  find  some  puff  of  some  regular 
physician  for  some  operation  performed,  or  some  cure  effected,  or 
some  skill  puffed !  To  say  that  such  a  local  notice  or  such  a 
eulogistic  communication  appeared  without  the  knowledge  or 
consent  of  that  physician  or  surgeon,  is  ninety-nine  cases  out  of  a 
hundred,  an  entire  mistake. 

These  “  practices  of  empirics”  are  daily  published  among  us  by 
the  authority  or  permission  of  our  regular  brethren,  and  it  is  dis¬ 
creditable  and  oftentime  disgraceful  for  them  thus  to  allow  them¬ 
selves  to  be  advertised  and  placarded  over  the  whole  land.  Disci¬ 
pline  is  demanded  for  these  daily  outrages,  as  well  as  for  that 
fashionable  violation  of  those  who  “  boast  of  cures  or  remedies,” 
“or  perform  similar  acts.”  This  great  guide  of  the  profession, 
so  justly  held  in  hallowed  regard  by  every  true  member,  holds  up 
to  the  scorching  reprobation  of  all  men,  and  as  “  derogatory  to 
professional  character,”  “  practices  of  empirics”  like  those  quoted, 
and  which  in  the  language  (Sec.  4th,)  of  the  same  instrument, 
find  a  counterpart  in  acts  which  “dispense  a  secret  nostrum, 


18 


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whether  it  be  the  composition  or  exclusive  property  of  himself  or 
others.”  “  It  is  also  reprehensible  for  physicians  to  give  certifi¬ 
cates  attesting  the  efficacy  of  patent  or  secret  medicines,  or  in 
any  icay  to  promote  the  use  of  them .”  We  have  italicized  the  last 
sentence  because  of  the  wide-spread  demoralization  upon  this,  as 
upon  the  other  reprehensible  “practices”  named,  and  in  order 
that  the  Association  may  see  the  importance  and  necessity  of 
taking  high  and  fearless  grounds  upon  their  discouragement  and 
suppression.  It  is  as  much  the  duty  of  every  Medical  Society  to 
sustain  ethics  and  promote  social  elevation,  as  it  is  to  advance  in 
knowledge.  For  any  such  Society  to  decline  to  do  so,  or  to  refuse 
to  discipline  those  who  violate  the  Code  with  impunity,  is  but  to 
encourage  these  and  other  reprehensible  “  practices.”  If  this 
Association  has  not  the  back-bone  to  come  out  fairly  and  squarely 
upon  these  practical  questions  of  every  day  life,  and  to  demand 
that  all  its  members  shall  take  and  maintain  the  bold  and  high 
grounds  of  high  churchmen  thereupon,  then  you  will  greatly 
disappoint  its  best  friends,  and  do  injustice  to  our  suffering  pro¬ 
fession. 

An  omission  thus  to  discharge  the  high  duties  voluntarily 
assumed  in  the  institution  of  our  new  organization,  is  an  evidence 
that  a  mistake  was  made,  an  error  committed,  in  the  selection  of 
the  present  Chairman  of  your  Executive  Committee.  He  did  not 
seek,  but  avoided,  the  delicate  and  important  duty  devolving 
upon  the  Committee  of  having  regard  to  the  status  of  our  mem¬ 
bers.  For  himself,  he  repeats,  that  he  had  not,  nor  has  not,  any 
selfish  aims — “no  friends  to  reward  nor  enemies  to  punish  ”  in 
accepting  his  appointment  as  Chairman.  Let  it  be  repeated,  that 
the  existence  of  the  Association  comes  from  the  necessities  aris¬ 
ing  from  the  acknowledged  demoralization  alluded  to.  There 
should  animate  us  all  such  a  broad  charity  and  pride  of  member¬ 
ship,  that  laying  aside  all  fastidiousness  and  over-sensitiveness, 
we  should  not  repel,  but  invite  oversight  and  scrutiny  into  our 
conduct  and  status. 

Such  a  feeling  pervading  our  ranks,  opposed  as  it  must  be  to 
any  wilful  violation  of  duty,  would  render  the  duty  of  the  Com¬ 
mittee  pleasant  and  easy.  In  relation  to  this  feature  of  our 
duties,  the  official  attention  of  your  Chairman  has  been  called, 
since  our  last  meeting,  to  a  medical  publication  issued  by  the 


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19 


very  prominent  and  respectable  house  of  Messrs.  Wade,  Boykin 
&  Co.,  of  Baltimore,  involving  the  names  of  two  of  our  members? 
Drs.  G.  M.  Roberts  and  George  L.  Kirby.  The  official  notice 
came  from  a  prominent  source  iu  the  Association,  with  the  sug¬ 
gestion,  based  on  no  unkindness  surely,  that  the  Chairman  would 
make  an  investigation,  as  the  matter  was  in  the  pale  of  his  duties. 
The  publication  merely  advertised,  as  is  the  custom  of  Druggists, 
what  is  called  “  Every  Body’s  Pill,”  and  made  such  a  reference  to 
the  names  of  these  gentlemen  as  was  calculated  to  leave  the  in¬ 
ference  that  they  approved  and  recommended  this  “  Pill.”  The 
Chairman  accordingly  addressed  an  official  communication  to 
each  of  these  members  in  the  form  more  of  an  enquiry;  adding 
the  suggestive  remark,  that  if  their  names  appeared  with  their 
consent,  their  authority  thus  to  bolster  up  a  remedy  in  that  form, 
was  improper,  and  looked  out  of  place.  He  stated  also  that  if 
otherwise  used,  it  was  a  duty  to  themselves,  to  the  Association, 
and  to  the  profession,  to  see  to  it  that  their  names  in  such  rela¬ 
tion  were  stricken  out  of  any  such  publication.  Dr.  Roberts 
replied,  in  a  becoming  tone  and  temper,  to  the  effect  that  his 
name  was  published  without  his  authority.  Dr.  Kirby  replied  as 
follows,  and  your  Chairman  is  alone  responsible  in  submitting 
his  letter  and  the  reply  as  a  part  of  this  official  report;  taking 
the  ground  that  the  official  correspondence  becomes  the  property 
of  the  Association,  and  that,  from  the  nature  and  relations  of 
this  case,  it  is  his  duty  to  incorporate  the  same  in  this  Report: — 

Goldsboro,  N.  C.,  August  4th,  1874. 

Dr.  S.-  S.  Satchweel, 

Chairman  Executive  Committee  Eastern  Medical  Association  : 

My  Dear  Sir  : 

Your  favor 

informing  me  that  some  member  of  our  Society  had  called  the  attention  of  the 
Executive  Committee  to  my  name  published  to  a  circular  from  Wade,  Boykin 
&  Co. ,  advertising  a  Pill  called  “Every  Body’s  Pill  ”  is  at  hand.  I  should 
have  written  you  in  reply  sooner  but  was  waiting  to  hear  from  Dr.  Boykin. 
The  publication  was  unauthorized  by  me,  as  I  have  never  seen,  used,  or  recoin, 
mended  any  one  else  to  use  the  “Pill”  mentioned.  But  I  do  not  see  that 
this  charge  is  made  in  any  other  than  a  spirit  of  maliciousness,  in  which  I 
hope  you  do  not  participate.  I  would  like  for  your  correspondent  who  makes 
the  charge,  or  any  one  else,  to  point  out  the  clause  of  Medical  Ethics  as  adopted 
by  the  American  Medical  Association  which  is  violated,  even  if  I  had  con¬ 
sented  to  this  circular  as  published.  The  “Pill”  is  neither  a  secret,  or 


20 


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patent,  or  proprietary  remedy,  as  you  perhaps  well  know,  as  Dr.  Boykin 
writes  me  that  he  had  furnished  you  with  the  formula,  as  well  as  every  other 
physician  of  the  State  of  his  acquaintance. 

It  seems  to  me  that  some  of  the  small  fry  are  exceedingly  anxious  to  bring 
themselves  into  notice  by  catching  at  this  thing  and  getting  up  a  controversy, 
but  I  do  not  propose  to  gratify  them. 

If  it  were  true  ,  as  charged,  that  this  publication  was  made  with  my  consent, 
would  it  be  any  more  a  violation  of  Medical  Ethics  than  to  prescribe  Tilden’s 
or  Sharpe  &  Dohme’s  Elixir?  Clearly  not  so  much.  Iam,  and  my  record 
will  prove  it,  as  great  a  stickler  for  Medical  Ethics,  and  have  adhered  to  the 
Code  as  closely  as  any  physician  in  the  State  ;  and  I  do  not  propose  to  be 
annoyed  by  these  would-be  custodians  of  every  Dr.’s  Proff.  character- 
If  your  correspondent  is  not  satisfied,  tell  him  to  make  out  his  charges  in  due 
form,  and  send  me  a  copy,  and  perhaps  I  will  give  him  the  notoriety  he 
wishes  at  the  next  meeting  of  the  Eastern  Medical  Association. 

Yours  truly, 

Geo.  L.  Kirby. 

To  this  communication  the  Chairman,  upon  his  own  official 
responsibility,  as  aforesaid,  felt  it  his  duty  to  make  the  following 
official  reply : 

Rocky  Point,  N.  C.,  ) 

October  14th,  1874.  \ 

Dr.  George  L.  Kirby, 

Dear  Doctor  : 

It  was  mv  intention  to  have  written  to  you 
pefore  now,  in  acknowledgment  of  your  official  communication  of  the  4th  of 
August  last.  True,  I  am  not  able  to  plead  such  a  constant  pressure  of  pro¬ 
fessional  engagements  as  to  have  had  no  time  for  this  official  service.  But  I 
decided  that  your  letter,  in  answer  to  mine,  calling  your  attention  to  the  publica¬ 
tion  of  your  name  as  an  endorsement  of  “  Every  Body’s  Pill,”  as  set  forth  in  a 
circular  issued  by  Messrs.  Wade,  Boykin  &  Co.,  of  Baltimore,  did  not  call  for 
any  special  action  on  the  part  of  the  Executive  Committee,  and  therefore,  I 
did  not  deem  it  important  to  reply  earlier  than  now. 

The  assertion  on  your  part,  that  such  a  use  of  your  name  was  unauthorized, 
is  sufficient  to  prevent  the  presentation  of  charges  against  you,  and  I  doubt 
not  you  will  see  to  it,  if  you  have  not  already  done  so,  that  your  name  shall 
cease  to  appear  in  the  manner  and  form  indicated. 

Here  I  would  close,  were  it  not  that  some  expressions  in  your  communica¬ 
tion  suggest  a  more  extended  reply.  It  was  a  sense  of  duty  imposed  upon  the 
Executive  Committee  by  the  Constitution  of  our  cherished  Association,  which 
prompted  my  first,  as  it  does  this  second,  official  communication.  The  per¬ 
sonal  friendship  so  long  existing  between  us,  and  the  high  estimate  so  justly 
placed  upon  your  fine  reputation  and  standing  in  our  noble  profession,  added 
to  my  anxiety  that  your  name  should  not  appear  in  any  manner  that  might 
excite  the  shadow  of  a  shade  of  suspicion  that  you  had  violated  in  any  mate¬ 
rial  degree  our  Code  of  Ethics,  I  repeat  that  your  prominence  in  the  pro- 


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21 


fession  made  your  professional  brethren  more  solicitous  that  an  opportunity 
should  be  afforded  you  of  removing  every  vestige  of  doubt  that  you  had  given 
your  authority  to  the  countenance  and  support  of  any  such  nostrum.  It  was 
therefore  with  sincere  regret  that  I  see  an  expression  of  your  unwillingness  to 
receive  enquiries  bearing  upon  this  question  ;  for  I  was  in  hopes  that  the 
standing  of  the  Executive  Committee  was  sufficient  to  insure  your  confidence 
that  they  were  able,  as  willing,  to  make  a  proper  decision  as  to  whether  our 
source  of  information  in  relation  to  your  professional  relations  to  this  “Pill” 
was  such  as  would  authorize  us  to  call  your  attention  to  the  same.  The  Com¬ 
mittee  do  not  listen  to  complaints  from  an  unworthy  quarter.  They  claim  to 
be  competent  to  make  a  just  discrimination  in  this  important  relation,  and  to 
be  so  far  competent  for  our  responsible  duties,  as  not  to  allow  our  members 
to  be  annoyed,  through  our  official  channel,  with  complaints  and  charges  from 
an  irresponsible  and  incompetent  source.  In  this  case  our  informant  has 
kind  feelings  for  you,  is  one  of  the  most  useful  members  of  our  Association, 
and  a  leading  ph}Tsician  of  the  State  ;  but  at  the  same  time,  warm  in  his  ad¬ 
vocacy  of  the  Association,  as  he  is  justly  jealous  of  the  honor  of  the  profession. 
In  saying  therefore,  as  you  virtually  do,  that  the  suggestion  for  the  enquiry  is 
founded  in  a  spirit  of  “  maliciousness,”  in  which  you  hope  I  do  (you)  not  parti¬ 
cipate.  Your  remarks  may  be  construed  into  an  insinuation  against  me  as  un¬ 
generous,  as  it  is  unfounded  and  uncalled  for  ;  and  at  the  same  time  you  make 
an  unprovoked  assault  by  the  statement  upon  a  brother  practitioner  who  is  in¬ 
capable  of  the  motives  and  conduct  you  ascribe  to  him.  Because  that  brother 
unites  with  us  in  demanding  medical  improvement  and  reform,  and  is  solic¬ 
itous  that  we  all  should  walk  in  the  straight  and  narrow  line  of  duty  and  of 
ethics,  let  him  not,  nor  them  of  like  devotion,  be  accused  of  prejudice  or  un¬ 
kindness,  much  less  of  “maliciousness.”  The  traditions  and  instincts  of  the 
profession  rise  up  against  you  in  your  accusation  against  him.  While  as  hon¬ 
orable  gentlemen,  we  may  differ  in  some  scientific  and  other  points  of  profes¬ 
sional  interest,  let  us  have  charity,  that  peace  and  friendship  may  abound  Let 
us  keep  our  lamps  trimmed,  and  our  garments  unsoiled,  that  the  peace  and 
glory  of  the  profession  may  be  preserved.  In  all  the  temptation  and  trials 
which  beset  us,  let  us  so  act  that  principle  may  still  be  maintained,  to  the  end 
that  we  may  have  that  harmony  and  professional  Brotherhood  so  necessary  for 
the  good  of  the  profession,  as  well  as  for  our  own  personal  comfort  and  hap¬ 
piness  as  we  journey  along  over  the  rugged  paths  of  life. 

But  you  take  issue  with  me,  that  even  if  you  had  authorized  such  a  publica¬ 
tion  of  your  name,  it  would  be  no  infringement  of  any  portion  of  our  Code 
worthy  of  condemnation  or  notice.  I  am  pained  at  such  an  admission, 
because  I  regard  your  position  as  erroneous,  as  opposed  to  the  spirit  of  our 
Code,  and  as  calculated  to  work  mischief  and  demoralization  in  our  already 
demoralized  profession  in  North  Carolina.  Even  if  Wade,  Boykin  &  Co.,  have 
furnished  the  formula  of  this  “  Pill”  to  the  profession,  it  presents  no  excuse 
why  we  should  bear  testimony  to  its  value  ;  because  in  so  doing,  we  are  travel¬ 
ing  out  of  our  way  to  bolster  up  a  remedy  which  any  of  us  can  put  up  any 
hour,  and  we  had  just  as  well  furnish  public  evidence  to  every  druggist  in 
the  land  of  the  great  virtues  of  laudanum,  compound  cathartic  pills,  or  any 


22 


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other  compound  of  the  United  States  Dispensatory,  as  to  testify  specially  to 
the  efficiency  of  “  Every  Body’s  Pill.”  You  would  not  regard  it  as  profes¬ 
sional  to  see  the  physicians  around  you  bearing  public  evidence,  by  certificates, 
of  any  of  these  medicines  in  order  that  some  druggist  might  sell  them  more 
profitably,  when  his  means  of  such  profits  were  based  upon  this  very  certifi¬ 
cate  of  such  physicians.  You  deny  that  the  Code  condemns  such  a  practice  ;  I 
claim  that  if  there  is  no  direct,  out-spoken  clause  to  that  effect,  the  practice  and 
all  such  practices  meet  with  th’e  constructive  condemnation  of  the  same.  That 
able  Constitution  for  our  guidance,  is  compact  and  comprehensive,  and  em¬ 
braces  many  irregularities,  violations,  and  demands,  not  named  in  the  instru¬ 
ment,  but  clearly  inferred.  There  is  contained  in  it  much  lex  non  scripta  as 
imperative  upon  us,  as  are  the  duties  specially  enjoined.  Every  true  medical 
gentleman,  who  bears  in  his  bosom  the  inspiration  of  honor  and  duty  as 
obtained  from  this  Cdde,  admits  in  his  daiR  thoughts  and  practice,  that  there 
are  many  duties  and  requirements,  not  laid  down  in  it,  but  arising  from  its  obvious 
spirit  and  plain  requirements,  and  as  binding  upon  him  as  any  that  are  written • 
Now  is  it  any  excuse,  that  because  other  physicians  have  injured  the  profession 

by  certificates  such  as  those  now  under  consideration,  we  are  allowed  to  do 
likewise  ? 

There  is  a  peculiar  demand  upon  the  Eastern  Medical  Association  to  take 
and  maintain  a  high  stand  upon  this  and  kindred  violations,  because,  amid 
the  sad  demoralization  every  where  around  and  about  us,  we  profess  to  be  a 
beacon  light,  high  and  luminous,  amid  the  surrounding  gloom  and  darkness- 
If  I  have  read  correctly  our  Code,  and  if  I  do  not  misunderstand  its  meanings 
and  requirements,  written  and  unwritten,  as  interpreted  by  the  general  voice 
of  the  profession,  you  are  mistaken  in  your  views  ;  and  you  would,  in  my 
opinion,  justly  subject  yourself  to  charges  and  specifications  to  extend  the  sup¬ 
port  of  your  name  in  a  circular  to  any  remedy  gotten  up  and  advertised  like  that 
of  “Every  Body’s  Pill,”  or  to  allow  your  name  to  remain  published,  as  it  is? 
without  protest.  You  cannot  be  indifferent  to  the  signs  of  the  times,  as  with  hu¬ 
mane,  pleading,  notes  for  reform,  they  appeal  to  every  honorable  physician, 
to  strike  for  the  elevation  and  yet  higher  elevation  of  our  down-trodden  pro¬ 
fession.  The  medical  demagogue  above  all  other  demagogues,  now  more  than 
ever,  revels  and  luxuriates  in  that  prevailing  ignorance,  depravity,  and  corrup¬ 
tion  which  spreads  a  pall  of  gloom  over  the  whole  face  of  society,  and  chills  the 
hopes  and  aspirations  of  the  deserving  aud  honorable.  With  loud  professions 
of  devotion  to  the  Code,  which  in  his  heart  he  despises,  nothing  pleases  him 
more  or  nerves  him  more  in  his  ignominious  course,  than  loose  constructions 
of  its  provisions  or  a  failure  to  obey  its  mandates  by  others.  He  makes  up  by 
sweet  smiles,  honied  words  and  bombastic  talk,  hypocritical  cant  and  syco¬ 
phancy,  for  the  defects - of  a  shallow  brain  and  superficial  attainments  ;  and 

plies  his  vile  arts  now-a-days  with  greater  success  than  ever  before;  while  the 
modest  man  of  merit,  skill,  and  science,  is  neglected  and  even  abused  for  his 
devotion  to  duty  and  the  public  good.  Under  this  lamentable  condition  of  our 
profession,  it  becomes  us  all,  who  have  character,  skill,  and  talent  like  your¬ 
self,  to  unite  in  a  common  defence  and  a  common  cause.  Any  failure  to  stand 
by  our  Constitution  and  a  strict  construction  of  the  Code,  is  so  much  encour- 


Satch well’s  Executive  Report. 


23 


agement  to  quacks  and  the  whole  tribe  of  demagogues,  as  just  described;  and 
is  in  consequence  a  blow,  more  or  less  effective,  against  the  peace,  honor, 
dignity  and  welfare  of  the  profession.  We  cannot  be  too  careful  to  avoid  any 
and  every  thing  that  even  savors  of  a  violation  of  this  organic  charter  of  our 
adoption  and  allegiance  ;  for  as  we  disregard  its  spirit  and  requirements,  in 
the  same  proportion  do  we  injure  the  profession  and  suffer  in  our  character 
as  gentlemen. 

Yours  truly, 

S.  S .  Satchwell, 
Chairman  Executive  Committee 

Eastern  Medical  Association. 

It  is  time  that  this  whole  question,  as  alluded  to  in  said  Sec. 
4th,  Article  2nd,  Chapter  2nd,  of  our  organic  law,  should  be  defi¬ 
nitely  and  thoroughly  understood,  in  and  out  of  our  Association, 
and  beyond  the  possibility  of  doubt  or  circumlocution.  It  is 
respectfully  submitted  that  said  clause  does  settle  it  as  above  in¬ 
dicated.  That  it  may  be  properly  understood  and  truly  observed, 
has  been  the  only  motive  of  the  writer  in  dwelling  at  so  much 
length  upon  it. 

Moreover,  this  is  a  proper  place  for  him  to  repeat  that,  while 
he  lays  no  claim  to  infallibility,  much  less  does  he  claim  any 
prominence  or  superiority  over  the  feeblest  and  humblest  member 
of  this  Body.  He  has  only  sought,  he  says,  for  himself,  to  place 
truth  on  record  as  he  has  found  it,  and  to  set  forth  in  this  Report, 
duty,  as  he  understands  it.  We  all  know  that  he  who  seeks  to 
grapple  with  and  to  aid  in  eradicating  errors  and  evils,  as  they 
exist  in  our  regular  ranks — that  he  who  honestly  plies  himself  to 
the  arduous  task  of  medical  reform,  lays  on  no  Procrastian  bed  of 
ease :  but  provokes  opposition  and  arouses  animosities  against  him¬ 
self,  which  are  often  malignant  and  persistent.  This  has  always 
been  so  in  our  own  and  other  occupations,  and  thus  it  will  con¬ 
tinue  as  long  as  principle  needs  an  advocate,  or  truth  a  friend* 
The  Chairman,  in  all  solemn  truth,  can  say,  that  the  animus  and 
spirit  of  his  every  desire  and  act,  in  all  his  relations  to  the  public, 
medical  enterprises  and  medical  organizations  with  which  he  has 
been  and  is  now  connected,  is  to  mete  out  justice  to  every  one,  to 
do  good  to  his  profession,  and  to  aid  in  the  relief  of  suffering 
humanity.  If  his  sensibilities  are  awakened  at  the  downtrodden 
condition  of  our  common  calling,  there  is  no  desire  or  purpose 
to  underrate  or  do  injustice  to  any  brother:  but  rather  that  each 
one  should  have  all  that  is  due  him,  and  that  the  entire  profes- 


24 


Satchwell’s  Executive  Report. 


sion  should  be  elevated.  No  one  could  regret  more  than  himself 
any  apparent  injustice  that  might  seem  to  be  done  any  one  in  an 
official  capacity.  He  trusts  it  is  not  necessary  to  say  that  his 
official  references  in  this  paper  to  that  excellent  and  popular 
house  of  Messrs.  Wade,  Boykin  &  Company,  and  to  our  talented 
brother  Kirby,  are  based  on  no  unkindness  at  all,  but  spring 
alone  from  a  sense  of  duty  to  the  Association  and  to  the  profes¬ 
sion.  The  temptations  which  assail  us,  the  demoralizations 
which  abound,  are  so  many  warning  voices,  that  we  cannot  be 
too  careful  as  to  infringements  upon  the  Code  of  Ethics.  That 
Code,  let  it  be  repeated,  is  only  another  name  for  the  high  charar- 
ter  of  a  Medical  gentleman.  That  word  gentleman ,  in  the  vocabu¬ 
lary  of  words  of  your  Committee,  is  one  of  vast  meaning,  of  high 
requirements,  and  covers  the  whole  ground  of  duty.  No  man  can 
be  a  true  gentleman,  who  has  not  within  him  that  dislike  of 
meanness,  that  unswerving  attachment  to  integrity,  honor,  prin¬ 
ciple  and  patriotism,  which  is  so  far  above  price  that  it  cannot  be 
purchased  with  all  the  gold  in  the  United  States  Treasury.  If 
all  our  brethren  were  of  this  stamp,  there  would  be  no  need  of 
the  Code.  Every  gentleman  bears  it  in  his  own  bosom  and  in¬ 
stinctively  acts  it  out  in  his  daily  life.  But  this  “lamp  to 
our  feet  and  light  to  our  pathway”  is  an  indispensable  guide 
because  of  that  frailty  and  depravity  of  human  nature,  found  in 
ours  as  well  as  other  pursuits.  Let  us  therefore  cling  with  un¬ 
changing  pride  and  devotion  to  this  “law  unto  ourselves,”  to  the 
end  that  not  one  jot  or  tittle  shall  be  abated  of  the  promises  of 
discredit,  dishonor,  and  punishment,  as  well  as  of  good  character, 
renown,  and  success,  which  it  holds  out  to  all,  according  as  each 
may  choose  for  himself,  the  one  or  the  other. 

Mr.  President,  let  us  see  to  it,  that  the  high  and  n:ble  mission 
of  our  infant  Society  suffers  no  depreciation  at  the  hands,  and  by 
the  remissness  of  conduct  of  its  members.  It  was  formed  amid 
a  blaze  of  enthusiasm  which  excited  stirring  hopes  and  high  ex¬ 
pectations  on  the  part  of  the  truest  and  best  friends  of  the  pro¬ 
fession  in  the  State.  If  that  enthusiasm  should  be  changed  into 
indifference  or  neglect,  chilliness  and  mortification  will  possess 
the  hearts  and  blast  the  hopes  of  these  faithful  disciples  of  the 
cause  of  medical  progress  and  elevation,  and  its  enemies  will  re¬ 
joice  and  chuckle  at  our  lack  of  vigor  and  determination,  and 


Satch well's  Executive  Report 


25 


erect  their  monuments  of  triumph  over  our  defeat.  Be  not  de¬ 
ceived.  The  demon  of  unrighteousness  and  of  corruption  stalks 
abroad  in  the  whole  land,  gaining  his  victories  of  money  and 
unhallowed  influence  among  the  masses  of  ignorance,  so  alarm¬ 
ingly  on  the  increase  in  North  Carolina.  The  spirit  it  engenders 
and  makes  ruthlessly  active  undermines  the  fair  fabric  of  our 
own  and  of  other  professions,  to  the  extent  that  professional  suc¬ 
cess  now-a-days,  is  no  evidence  of  merit,  or  skill,  or  talent.  It 
has  ever  been  thus  after  all  wars,  such  as  that  which  has  devas¬ 
tated  our  land,  and  debauched  the  public  morals.  Terrible  revo¬ 
lutions.  like  that  which  has  so  lately  prostrated  our  native  section, 
and  dried  up,  by  its  withering  blasts,  the  fountains  of  honor,  good 
faith,  and  integrity  of  purpose  and  principle,  always  elbows  aside 
the  ablest,  noblest,  and  best  of  the  land  that  is  overcome,  and 
hunts  up  and  brings  to  the  surface,  the  smallest  and  meanest  of 
men  to  receive  the  favors  and  success  of  the  professions,  as  well  as 
of  the  body  politic.  Look  around  you  in  society,  and  over  our 
whole  Southern  land  since  the  war  and  see  who  are  those  in  our 
own  and  other  professions,  as  well  as  without,  upon  whose 
shoulders,  wealth  and  success  mainly  rest;  and  you  will  find  that, 
with  rare  exceptions,  they  are  those  who  have  proved  untrue,  alike 
to  the  instincts  and  teachings  of  manhood,  professional  duty,  and 
patriotism;  and,  following  the  god  of  mammon,  have  fallen  into 
the  sloughs  of  deception,  treachery,  and  a  betrayal  of  every  true 
principle  of  an  honorable  gentleman. 

While  then  our  worthiest  and  best,  in  the  medical  profession, 
disdaining  to  sink  to  the  low  level  of  the  means  to  obtain  practice 
now  tolerated  by  the  prevailing  corruptions  and  unscrupulous 
desire  lor  success  everywhere  exerting  a  controlling  influence  in 
society,  are  so  generally  elbowed  aside,  or  supplanted  by  the 
brazen,  arrogant,  ignorant,  empirics  and  crafty  medical  preten¬ 
ders,  with  and  without  Diplomas,  let  it  be  repeated,  that  the  garb 
of  success  is  as  much  or  more  a  badge  of  dishonor  and  demerit  as 
of  modest  merit,  and  true  worth  and  skill.  But  it  will  not  be 
always  that  the  dark  and  disheartening  clouds  of  ignorance,  de¬ 
lusion,  and  demoralization  will  thus  abound  to  sustain  the  un- 
worthy  over  the  worthy.  It  cannot  always  be  that  darkness 
hides  the  light,  that  brainless  demagogues  receive  the  rewards 
withheld  from  the  intellectual,  deserving,  and  skillful  practi- 


26 


Annual  Address. 


tioner,  or  that  vulgar  manners,  rowdyism,  and  grovelling  natures 
bear  away  the  palm  of  popular  applause  from  the  refined  gentle¬ 
man  and  accomplished  physician.  “The  mills  of  the  gods  grind 
slowly  but  they  nevertheless  grind  finely  and  surely.”  Retribu¬ 
tive  justice,  so  tardy,  as  the  results  of  the  war,  still  deform  society 
and  overshadow  the  land,  already  casts  before,  the  bright  harbin¬ 
ger  of  its  coming.  The  gready  vultures  who  have  so  long  been 
fattening  in  ours  and  other  professions,  and  devouring  the  body 
politic,  are,  under  the  redeeming  spirit  of  the  times  and  the  up¬ 
heaving^  of  popular  indignation,  made  unwillingly  to  unloose 
their  clutches  and  to  decrease  their  depredations.  Principle 
again  rises  as  the  uplifted  hand  of  despotism  is  withdrawn  and 
the  people,  down  upon  meanness  and  corruption,  again  come 
forth  in  the  manhood  which  is  born  of  the  inspirations  of  free¬ 
dom. 

Then  let  us  still  persevere  in  coming  to  the  rescue  of  our  pros¬ 
trated  but  always  noble  profession.  Let  us  continue  to  fight  the 
good  fight,  that  truth  may  abound,  science  prevail,  good  be  done, 
and  humanity  promoted.  The  poverty  and  trials  now  upon  us 
in  our  chosen  profession  are  but  the  furnaces  of  affliction  through 
which  we  are  passing  to  try  of  what  strength  and  metal  we  are 
made.  The  physician  who  remains  silent  under  the  prevailing 
ignorance  and  wrong-doing,  is  derelict  in  his  duty  to  the  profes¬ 
sion.  Any  timidity  shown  by  this  Association  in  taking  advan¬ 
tage  of  the  vantage  ground  already  gained,  or  any  failure  to  move 
onward  prudently  but  fearlessly  in  its  professed  warfare  upon 
existing  errors  and  evils  in  our  ranks,  will  not  only  be  inconsist¬ 
ent  with  our  profession,  but  be  the  cause  of  our  loosing  strength 
and  prestige  from  the  discouraging  infiuence  of  such  a  hesitating 
policy  upon  many  of  its  warmest  supporters  and  best  friends. 
While  we  enrich  the  pages  of  our  history  with  memorable  and 
valuable  facts  in  our  science  and  art,  and  do  all  in  our  power  to 
promote  the  public  health,  and  to  subserve  the  interests  of  hu¬ 
manity,  let  us  also  strive  continuously  to  be  fair,  and  just,  one  to 
another — to  be  liberal  and  charitable  in  all  things  and  to  all  men. 
and  so  keep  our  own  arm-or  clean  and  bright,  that  we  may  the 
better  aid  in  those  things  which  contribute  to  the  brightness  and 
effulgence  of  our  escutcheon.  It  is  only  by  the  prevalence  of 
these  motives,  sentiments,  and  principles,  in  the  bosom  of  us  all, 


Proceedings,  &c 


27 


that  this  Association  can  meet  a  just  public  expectation,  or 
accomplish  the  high  mission  it  assumes.  It  is  only  by  such  a 
<lischarge  of  duty,  disregarding  the  enticing  allurements  of  a 
fickle  popular  applause,  and  unmoved  by  the  abuse  of  those  whose- 
opposition  is  praise,  that  the  medical  scrubs  and  medical  gam” 
biers  of  our  regular  ranks,  infesting  almost  every  township 
in  our  State,  as  well  as  every  town  and  city,  can  be  appreciated 
as  they  deserve,  and  induced  to  hang  their  heads  in  shame  before 
the  light  and  power  of  our  invincible  progress.  With  reform, 
progress,  and  an  elevated  standard  of  ethics  as  our  motto,  we  have 
every  inducement  to  move  onward,  and  to  strive  continuously 
for  a  higher  and  yet  higher  grade  of  excellence  and  usefulness. 

Respectfully  submitted, 

S.  S.  Satchwell,  Ohm’n. 

H.  W.  Faison. 

Newbern,  N.  0.,  Nov.  4th,  1874. 

Dr.  Kirby  then  made  a  brief  yet  pointed  address  to  the  Society,  in  which 
lie  removed  any  adverse  opinion  as  to  his  ethical  status,  and  satisfactorily  ex* 
plained  himself  with  reference  to  any  misconception  that  may  have  been 
lormed  in  the  reading  of  Dr.  Satchwell’s  Executive  Report. 

Dr  Satchwell  rejoined,  disclaiming  any  personal  feeling,  but  claiming  that 
his  action  was  based  upon  a  sense  of  duty  as  Chairman  of  the  Executive  Com¬ 
mittee. 

A  motion  was  made  by  Dr.  Charles  Duffy,  Jr.,  to  receive  and  adopt  Dr. 
Satchwell’s  report. 

Dr.  Kirby  objected  to  the  report,  with  the  correspondence  between  himself 
and  Dr.  Satchwell,  being  published. 

Dr.  CKHagau  fully  endorsed  the  report  with  the  correspondence  attached. 

Dr.  Faison  explained  that,  as  one  of  the  Executive  Committee,  he  had 
signed  the  report,  but  declined  any  connection  with  the  correspondence  be¬ 
tween  Dr.  Satchwell  and  Dr.  Kirby. 

Dr.  Robinson  moved  to  adopt  the  report  without  the  correspondence,  as  an 
amendment  to  Dr.  Duffy’s  motion.  Lost. 

Dr.  Duffy's  motion  was  adopted. 

Dr.  Duffy  submitted  a  motion  to  appoint  a  Committee  of  Publication. 
Adopted. 

The  President  appointed  Drs.  Frank  Duffy,  Geo.  S.  Attmore  and  J.  F.  Long. 

On  Dr.  Duffy’s  motion  the  President  appointed  an  Executive  Committee  as 
follows  :  Drs.  S.  S.  Satchwell,  C.  J.  O’Hagan  and  H.  W.  Faison.^ 

The  following  committee  was  appointed  to  map  out  work  for  the  next  meet¬ 
ing:  Drs.  Charles  Duffy,  Jr.,  Cox,  Robinson  and  Mattocks,  who  are  to  report 
at  the  next  meeting. 


Annual  Address 


OS 

/v  O 


On  motion  of  Dr.  Attmore,  the  President  was  authorized  to  appoint  a  gen¬ 
tleman  to  write  essays  for  the  next  meeting.  He  made  the  following  appoint¬ 
ments:  Dr.  Robinson,  on  the  Physiological  and  Therapeutical  effects  of  Gelsem- 
inum;  Dr.  Frank  Duffy,  on  the  action  of  Quinia;  Dr.  Charles  Duffy,  Jr.,  on  Ma¬ 
larial  Fever;  Dr.  Mattocks,  on  Urethral  Stricture. 

On  motion  of  Dr.  Satchwell  the  thanks  of  the  Association  were  tendered  to 
the  Newbern  Steam  Fire  Engine  Company,  and  the  citizens  and  physicians  of 
Newbern  for  their  elegant  hospitality.  And, 

On  motion  of  Dr.  Faison  thanks  were  also  tendered  to  the  Railroads  extend¬ 
ing  courtesies  to  members  and  delegates. 

Adjourned  until  Friday  morning. 


(Appendix  A. ) 


Annual  Address  by  Dr.  C.  Duffy,  Jr. 

Gentlemen  of  the  Eastern  Medical  Association : 

Assembled  at  this,  our  first  annual  meeting,  when  among  other 
duties  that  of  preparing  and  equipping  ourselves  for  another  year 
is  incumbent  upon  us,  the  occasion  very  naturally  suggests  the  in¬ 
quiry,  what  advantage  to  ourselves  and  to  our  community  do  we 
expect  to  grow  out  of  our  efforts  in  the  formation  of  our  Society? 
Is  there  really  a  necessity  for  such  an  organization  as  this  one  we 
have  instituted?  And  what  special  work  is  there  for  us  to  do  for 
“the  advancement  of  medical  knowledge,  the  elevation  of  profes¬ 
sional  character,  and  the  promotion  of  all  measures  of  a  profes¬ 
sional  nature  that  are  adapted  to  the  relief  of  suffering  humanity”? 

Before  proceeding  with  the  subject  matter  of  these  inquiries,  I 
cannot  resign  my  privilege  of  congratulating  you  on  the  propor¬ 
tions  our  Association  has  attained,  in  numbers,  esprit  da  corps , 
and  healthful  social  sentiment.  Time  for  development  and  ma¬ 
turation  is  essential  in  all  bodies,  corporate,  as  well  as  individual, 
and  surely  the  first  year  of  our  existence  has  not  been  barren  of 
results  to  us.  Already  fifteen  Counties  are  represented  on  our 
roll  of  members,  and  a  zeal  commensurate  with  our  contemplated 
objects  seems  to  have  pervaded  our  entire  organization.  I  am 
pleased  also  to  note  our  beginning  in  “the  advancement  of  med¬ 
ical  knowledge.”  At  our  first  semi-annual  meeting,  in  Wilson,  a 
successful  aspiration  of  the  stomach  through  the  abdominal  walls 
for  the  evacuation  of  a  poisonous  dose  of  laudanum,  was  reported.* 


*By  Dr.  Hyatt,  Kinston. 


Annual  Address 


29 


In  this  we  have  another  exemplification  of  the  utility  of  cultivat¬ 
ing  a  more  implicit  reliance  on  ourselves  in  emergencies,  and  not 
blindly  adhering  to  the  belief  in  the  necessity  that  a  measure 
should  always  receive  the  stamp  of  authority  before  we  may  adopt 
it. 

Lastly,  questions  of  Medical  Ethics  have  received  their  deserved 
notice  in  our  deliberations,  and  on  their  discussion  we  hare 
erected  a  higher  platform  of  principles,  and  evinced  a  determina¬ 
tion  to  stand  squarely  on  it.  Although  in  this  our  exhibit,  noth¬ 
ing  brilliant  or  remarkable  appears,  there  is  at  least  something  of 
promise  for  our  future,  something  of  hope  that  our  cherished 
objects  will  be  accomplished. 

Our  Association  is  the  offspring  of  a  necessity  which  could 
tolerate  no  longer,  postponement  of  our  beginning  in  the  good 
work  of  medical  reform.  The  demands  of  progress,  that  the  medical 
history  of  Eastern  North  Carolina  shall  be  written  and  utilized 
to  science,  are  imperative,  and  must  be  met  promptly  by  the  men 
of  our  generation.  The  three  hundred  physicians  of  our  section 
who  do  not  belong  to  any  medical  organization,  or  have  not  at¬ 
tended  the  meetings  of  any,  since  the  war,  must  be  brought  to¬ 
gether  in  harmonious  action  in  the  interest  of  medicine :  their 
testimony  is  needed  on  many  unsettled  points.  It  is  our  busi¬ 
ness  to  see  that  no  effort  has  been  lacking  on  our  part  to  enlist 
them  in  so  important  a  service,  and  I  trust  there  is  no  one  among 
us,  who  does  not  feel  it  incumbent  on  himself  to  devote  his  entire 
strength,  his  every  energy  to  the  accomplishment  of  results  so 
full  of  promise  to  us.  Let  us  hope  there  is  no  one  of  us  who 
would  not  welcome  the  opportunity  to  serve  in  any  capacity  in 
the  promotion  of  our  art:  and  where ,  I  would  ask  you,  is  there  a 
more  inviting  field,  a  richer  harvest  for  our  labors,  than  this  very 
one,  wherein  we  have  inaugurated  them?  How  much  of  encour¬ 
agement  and  cheer  is  there  in  the  reflection,  that  mines  of  scien¬ 
tific  wealth  may  be  opened  up  in  our  midst  by  ceaseless  and  un¬ 
tiring  effort,  and  that  some  latent  spark  of  genius  may  be 
kindled  into  a  blaze  of  resplendent  light,  whose  lustre  may  serve 
as  a  beacon  to  guide  us  over  untrodden  ways,  and  to  brighten  up 
the  dark  uncertain  wilderness  in  our  front!  Let  no  man  pre¬ 
sume.  to  assert  that  the  climate  of  our  section  is  unfavorable  to 
intellectual  development  and  growth.  Our  Gaston,  our  Stanlys, 


30 


Annual  Address 


our  Speights,  our  Badger,  and  a  host  of  others  of  the  legal  pro¬ 
fession  who  have  arisen  to  eminence  among  us,  would  controvert 
any  such  notion.  And  just  here,  may  we  not  get  a  lesson  of  im¬ 
portance  to  ourselves  out  of  the  fact  that  our  neighbors  of  the 
“  Bar,”  arrive  at  positions  of  eminence  not  on  account  of  inherent 
intellectual  superiority  so  much,  as  by  the  constant  use  of  their 
faculties,  brightened  by  the  influence  that  must  necessarily  result 
from  “  meeting  antagonistic  opinions.”  from  the  rubbing  together 
of  minds  in  the  inevitable  routine  of  their  labors?  Do  we  want 
a  stronger  plea  for  the  necessity  of  medical  organizations?  Is  it 
not  evident  to  the  most  superficial  observer  that  from  this  friction 
of  minds  must  come  the  motive  power  we  want  now ,  before  any 
other  one  thing?  Is  it  not  evident  that  to  increase  the  mental 
capacity  of  the  devotees  of  any  science,  is  equivalent  to  the  ad¬ 
vancement  of  the  science  itself?  Have  we  need  of  the  increase 
of  our  mental  capacities  ?  Suppose  we  were  placed  fully  abreast  of 
the  march  of  progress, — suppose  we  were  in  possession  of  every  fact 
known  to  the  profession  to-day,  how  long ,  let  me  ask  you,  would  we 
maintain  our  place  in  that  march,  without  the  ever  restless  spirit 
of  inquiry  and  research,  whose  very  existence  depends  on  the 
vitalizing  influence  of  antagonistic  opinions  ? 

Again,  organization  is  as  much  an  essential  for  our  advance" 
ment  in  a  moral  and  social  point  of  view,  as  for  intellectual  cul¬ 
ture.  By  frequent  reunions  we  learn  more  accurately  our  natures 
and  dispositions,  and  can  thereby  comprehend  more  fully  in  all 
their  bearings  the  rules  of  human  action  so  absolutely  essential 
for  the  maintainance  of  those  friendly  relations,  on  which  all 
right  social  government  is  based.  It  is  a  part  of  human  nature, 
and  the  progress  of  civilization  will  require  many  years  to  do  it 
away,  that  intimacies  existing  between  individuals  offer  a  strong 
check  to  their  disposition  to  infringe  a  law  of  Ethics  on  account 
of  the  temporary  personal  inconvenience  its  operation  might 
cause.  A  man  is  not  so  likely  to  injure  a  friend  by  the  exercise 
of  selfish  proclivities,  as  one  about  whom  he  neither  knows  nor 
cares  anything. 

Entertaining  these  views  in  regard  to  medical  organizations, 
it  is  clearly  our  duty  to  bestir  ourselves  to  put  into  operation 
agencies  so  full  of  promise  to  us,  so  sure  of  positive  results;  agen¬ 
cies  out  of  whose  operation  will  grow  a  professional  energy  tend- 


31 


Annual  Address. 


ing  toward  a  higher  moral  and  intellectual  status  for  our  mem¬ 
bers,  a  more  useful  and  efficient  corps  of  medical  attendants  for 
our  patients,  and  a  lively  accession  of  laborers  for  the  field  of 
medical  science.  From  what  other  single  source  could  you  ex¬ 
pect  results  of  like  importance  ?  Results  for  ourselves,  results 
for  our  community,  and  results  for  the  store-house  of  medical 
science  1 

Then  let  us  have  these  reunions;  let  us  send  them  into  every 
county  and  village  in  Eastern  North  Carolina,  that  our  brethren, 
scattered  as  they  are  over  thinly  settled  districts,  with  no  Rail 
Roads  or  other  easy  and  rapid  modes  of  transit,  may  no  longer 
be  deprived  of  adding  their  quota  to  the  current  fund  of  medical 
knowledge.  Until  we  have  done  this,  let  us  say  no  longer  of  our 
medical  brethren,  separated  in  many  instances  beyond  the  possi¬ 
bility  of  meeting  one  another  oftener  than  once  a  month,  that 
they  are  careless  and  indifferent,  and  feel  it  not  incumbent  on 
themselves  to  join  in  the  march  of  medical  progress;  nor  yet  that 
any  of  them  are  devoid  of  honor  and  decorum,  until  we  have 
further  extended  our  acquaintanceship  among  them,  and  built 
up  stronger  friendly  relations  with  them.  Complain  not  of  their 
disregard  of  the  Code  of  Medical  Ethics,  until  we  have  canvassed 
with  them,  its  provisions  and  settled  among  ourselves  what  is  the 
true  meaning  of  its  sections,  and  what,  its  accepted  teachings. 
Here  is  to  be  found  a  rule  and  guide  of  our  professional  conduct 
as  positive  in  its  results  as  any  rule  in  mathematics,  under  whose 
operation  comes  the  “right  ruling  of  conduct  in  all  directions 
under  all  circumstances,”  the  ruling  of  conduct  out  of  which  will 
grow  a‘“  rational  agent  animated  by  high  principles  of  virtue  *  * 
*  *  *  preferring  on  all  occasions  what  is  just  to  what  is  expe¬ 
dient.” 

Before  entering  upon  the  consideration  of  “special  work”  for 
our  Association,  I  would  do  away  with  the  prevailing  idea  among 
us,  that  because  we  have  no  hospitals  wherein  to  carry  on  investi¬ 
gations,  we  are  not  called  on  to  trouble  ourselves  about  unsettled 
medical  problems,  that  it  is  not  expected  of  us  whose  time  is 
almost  all  consumed  in  travelling  over  long  tedious  roads  to  find 
time  to  work  for  our  art,  that  our  surroundings  are  unfavorable 
for  any  such  work !  To  say  that  in  hospital,  is  scarcely  ever  seen 
the  beginning  of  a  disease,  and  that  in  very  many  instances  the 


32 


Annual  Address. 


ultimate  termination  of  the  same  is  unknown  ;  that  many  ques¬ 
tions  as  to  causation  and  prophylaxis  cannot  be  settled  by  any 
investigation  instituted  in  hospital,  and  that  the  converse  of  these 
conditions  holds  in  private  practice,  is  to  say  that  the  work  of  the 
physician  in  private  practice  is  a  necessity  to  the  complete  under¬ 
standing  of  many  propositions,  and  cannot  on  any  account  be 
dispensed  with.  Granted,  our  inconveniences  are  great,  they  can¬ 
not  be  pleaded  in  bar  of  our  responsibilities.  We  have  bound 
ourselves  by  acquiescence  in  the  injunctions  of  tiie  Code,  “  by 
unwearied  diligence  to  resort  to  every  honorable  means  of  enrich¬ 
ing  our  science;”  we  cannot,  therefore,  delegate  our  responsibili¬ 
ties  to  our  brethren  of  other  localities,  nor  can  we  expect  them 
to  work  out  our  problems  for  us.  Upon  ourselves  and  upon  none 
others  devolves  the  labor  of  preserving  and  utilizing  whatever  of 
valuable  material  we  may  find  in  our  way,  and  we  must  do  it,  if 
we  would  not  deserve  to  be  branded  laggards,  and  loafers  and 
spongers,  on  the  domain  of  progress. 

The  beginning  of  all  our  work,  I  hold  to  be,  the  formation  of 
County  Medical  organizations  in  our  District,  and  I  recommend 
that  this  Association  take  immediate  action  in  the  matter,  bv 
appointing  committees  of  one  from  every  county  represented, 
whose  duty  it  shall  be  to  canvass  with  the  purpose  of  organizing 
into  Medical  Societies,  the  physicians  of  their  respective  counties 
where  such  organizations  do  not  already  exist.  That  they  be 
instructed  in  case  of  failure,  in  any  instance,  in  their  attempts  at 
organization,  to  furnish  a  copy  of  Code  of  Ethics  to  every  neigh¬ 
boring  practitioner  not  already  in  possession  of  one,  and  that  they 
report  extent  and  result  of  their  labors  at  our  next  semi-annual 
meeting. 

The  study  of  malaria  belongs  to  us  of  necessity.  It  furnishes 
not  less  than  nine-tenths  of  all  our  cases.  It  is  a  theme  of  the 
most  vital  importance  to  us,  a  theme  which  has  baffled  the  devoted 
efforts  of  our  most  earnest  workers  “in  every  clime  and  in  every 
age.”  We  have  it  here  in  every  phase,  from  its  earliest  manifest 
effect  on  the  blood  corpuscule,  to  the  gravest  hemorrhagic  fever. 
Let  us  take  hold  of  it  with  becoming  zeal ;  let  us  institute  a  sys- 
tom  of  meteorological  observations,  including  carefully  recorded 
thermometric,  barometric  and  hygrometric  conditions,  together 
with  diligent  study  and  comparison  of  telluric  influences  with 


A K  N u A  L  A D DRESS. 


33 


reference  to  drainage,  evaporation,  elevation  and  distance  from 
sea.  proportion  of  forest  lands  and  character  of  growth,  degree  of 
cultivation  of  arable  lands,  source  of  supply  and  character  of 
drinking  water;  general  characteristics,  habits,  customs,  condi¬ 
tions,  occupations  and  dietary  of  population,  etc.,  so  that  having 
made  ourselves  more  thoroughly  acquainted  with  the  supposed 
endemic  influences,  we  may  at  least,  supply  more  intelligently 
the  proper  hygienic  measures  with  the  purpose  of  diminishing 
frequency  of  occurrence  and  virulence  of  fevers.  Are  variations 
in  climatic  influences,  alone  sufficient  to  account  for  variations 
in  malarial  manifestations?  or  do  variations  in  individual  sus¬ 
ceptibility  play  a  more  important  role  in  the  list  of  factors?  Do 
we  owe  our  escapes  from  malarial  attacks,  to  our  power  of  resist¬ 
ance,  lack  of  exposure  to  existing  causes,  or  temporary  absence  of 
malarial  poisons  ?  Is  malaria  a  constantly  and  regularly  opera¬ 
tive  materies  morbi  peculiar  to  such  climates  as  ours  ?  If  not, 
what  circumstance  or  combination  of  circumstances  sets  it  in 
motion  and  develops  its  power  ?  Is  it  innocuous  to  all  animals 
except  man  ?  Answers  to  these  questions  substantiated  by  a  care¬ 
fully  conducted  system  of  observation,  would  surely  be  productive 
of  good  results. 

Our  past  season  has  been  one  of  unprecedented  exemption  from 
malarial  manifestations.  Far  and  near,  from  almost  every  direc- 
tion,  our  citizens  present  the  appearance  of  robust  health.  Fre¬ 
quently  we  hear  from  a  district  notorious  for  its  fevers,  that  there 
has  not  been  a  case  of  sickness  through  the  whole  of  the  Autumn. 


May  we  not  hope  to  be  abte  to  say  why  this  is  so  ?  What  though 

we  fail  to  find  the  subtle  element,  the  veritable  malaria,  may  we 

« 

not  hope  our  investigations  will  disclose  at  least  the  u causes 
which  give  it  existence  and  potency  ”  ? 

Then  as  to  remedial  measures,  is  calomel  beneficial,  neutral,  or 
harmful,  in  its  influence  on  malarial  fevers  ?  Is  quinine  a  prophy¬ 
lactic  ?  Does  its  unlimited  use  abate  intensity  of  effects  as  a  cura¬ 
tive  agent?  Has  it  any  permanent  ill  effect  on  the  nerve  of  hear¬ 
ing  ?  What  its  influence  on  the  gravid  uteras  ?  I  would  suggest 
that  a  system  of  direct  questions,  with  a  view  of  eliciting  evidence 
on  the  above,  be  propounded  to  the  various  physicians  of  our  Dis¬ 
trict,  and  that  the  results  be  presented  at  our  next  regular  meeting, 
[f  with  all  our  opportunities  of  observing  in  this  particular  we 


34 


Annual  Address 


cannot  settle  these  important  questions,  at  least  to  our  own  satis¬ 
faction,  then  it  is  time  we  look  about  us  for  means  of  disposing 
of  unsettled  points,  other  than  by  observation. 

In  the  matter  of  physiological  and  pathological  differences  be¬ 
tween  the  white  and  colored  races,  we  have  opportunities  to  ren¬ 
der  important  service.  Let  us  enquire  whether  negroes  as  a  rule* 
are  more  obnoxious  to  scrofulous,  tuberculous,  and  syphilitic  dis¬ 
eases,  trismus  nascentium,  uterine  fibroids  and  cheloid  tumors ? 
Have  they  greater  immunity  from  malarial  diseases,  delirium 
tremens,  and  uterine  cancer?  If  so,  is  it  on  account  of  physio¬ 
logical  peculiarities?  Can  they  tolerate  as  well  as  the  white  man 
depletive  measures,  or  do  they  require,  as  has  been  asserted,  earlier 
supportive  treatment  in  the  management  of  their  disorders  ? 

Our  dietary  (particularly  in  the  country)  is  much  at  fault. 
Salted  meats,  generally  mess  pork  and  smoked  bacon,  supply  the 
greater  proportion  of  our  animal  foods;  these  prepared  by  the 
frying  process,  in  very  many  instances  empyreumatic  oils  are 
generated  and  ingested.  If  these  are  irritative  to  the  digestive 
surfaces,  need  we  wonder  that  there  are  so  many  dyspeptic 
troubles  among  our  laboring  classes?  and  may  we  not  hope  that 
many  of  the  so-called  “ liver  diseases”  would  vanish  before  the 
efforts  of  the  reformer  in  this  field  ? 

The  influence  of  fruits  on  the  health  of  our  community  requires 
investigation,  especially  that  of  the  Scuppernong  grape,  the  cul¬ 
ture  of  which  has  spread  all  over  our  Eastern  section,  and  which 
is  soon  to  assume  the  proportions  of  a  staple  product,  growing  in 
great  luxuriance  and  ripening  with  unerring  certainty.  A  popu¬ 
lar  notion,  shared  in  bv  many  physicians,  declare  it  an  unwhole¬ 
some  fruit,  capable  of  acting  as  an  exciting  cause  of  remittent 
and  intermittent  fevers.  Has  it  really  any  such  influence,  or  is 
it  merely  a  coincidence,  its  ripening  in  the  height  of  the  malarial 
season,  giving  rise  to  the  belief  that  it  is  a  morbific  agent? 

Can  any  change  be  advantageously  made  in  our  system  of  heat¬ 
ing  and  ventilating  our  houses,  or  does  the  present  mode  supply 
our  necessities  in  this  particular? 

The  matter  of  medical  education  should  occupy  us,  as  it  should 
every  organization  in  the  land.  Our  duty,  I  think,  consists  in  a 
determination  to  receive  no  would-be  student  of  medicine  into 
our  offices,  who  has  not  received  an  adequate  preliminary  educa- 


Annual  Address 


35 


f-ion,  and  who  is  not  endowed  with  a  fair  mental  capacity.  If,  as 
Dr.  Reynolds  has  stated  it,  “the  whole  of  oac. science  is  the  whole 
ol  all there  must  be  something  that  can  be  usefully  learned  out- 
sido  ^he  usually  pursued  medical  course,  and  at  least  a  part  of 
that  something,  should  be  taught  the  student,  before  he  begins  to 
deal  with  medical  technicalities.  A  constitutional  provision 
after  the  manner  of  that  of  the  Medical  Association  of  Alabama, 
would  meet  the  indications. 

Apropos  to  the  subject  of  climatology,  it  may  be  worthy  of  re¬ 
mark,  that  according  to  Dr.  Hewson  (Penn.  Hospital  Reports, 
\  ol.  2,  1869,)  the  barometer  may  be  relied  on  as  giving  the  most 
prompt  and  exact  information  about  weather  changes  as  likely  to 
effect  the  results  of  surgical  operations.  From  observations  of 


259  amputations,  Dr.  Hewson  found  percentage  of  mortality  as 
follows  :  Of  operations  done  while  barometer  was  ascending  10,7 
per  ct.  died;  while  barometer  was  stationary  20,6  per  ct.  died, 
and  while  descending  28,4  per  ct.  died.  If  this  is  only  half  truth, 
every  physician  should  keep  his  barometer  as  an  instrument  of 
necessity  in  determining  the  proper  time  to  do  his  capital  opera* 
tions  ;  or  at  any  rate  as  a  prognostic  aid  in  making  up  the  proba¬ 
ble  progress  and  results  of  his  cases. 

In  our  individual  capacities,  I  would  urge  the  necessity  of  pre¬ 
paring  ourselves  in  the  fullest  sense  of  the  word  with  the  qualifi¬ 
cations  for  making  accurate  diagnosis  of  our  cases.  Let  us  lay 
under  contribution  every  mechanical  aid  to  diagnosis  and  make 
strenuous  exertions  to  perfect  ourselves  in  its  use.  What  physi¬ 
cian  among  us  would  neglect  to  avail  himself  of  the  revelations 
of  the  test  tube  and  reagents?  Who  to-day  is  satisfied  with  a 
qualitative  measurement  of  temperature?  Who  is  competent  to 
encompass  with  the  unaided  senses  of  touch,  sight,  and  hearing 
the  various  signs  and  symptoms  of  the  most  familiar  disorders? 
Let  us  not  forget  what  the  great  Prof.  Meigs  said  of  diagnosis — 
that  “  it  is  in  practice  like  Captain  Greatheart  in  Bunyan,  en¬ 
countering  and  overthrowing  all  obstacles,  so  that  even  Apollyon 
himself  could  by  no  means  oppose  a  bar  to  his  habit  in  his  prac¬ 
tice  of  succeeding  always.”  A  twin  necessity  to  this,  is  our  obli¬ 
gation  to  overcome  the  public  horror  of  post  mortem  examinations. 
I  need  not  advert  to  our  constant  embarrassment  on  account  of 
this  difficulty — we  all  know  to  what  extent  it  prevails  in  our 


36 


Annual  Address 


section — and  our  chagrin  in  conseqence  will  be  readily  under¬ 
stood,  when  we  reflect  it  is  conceded  that  if  there  is  one  single  cir¬ 
cumstance  more  than  another  calculated  to  indicate  the  qualifica¬ 
tions  of  the  profession  in  any  locality,  that  circumstance  resides 
in  the  comparative  frequency  of  the  exercise  of  the  habit  of  con¬ 
firming  or  correcting  by  post  mortem  examinations,  convictions 
in  regard  to  pathological  conditions  supposed  to  have  existed 
during  the  life-time  of  the  patient.  Let  us  remember  this  when 
we  need  a  stimulus  to  the  performance  of  this  duty. 

Again,  as  to  therapeutics,  let  us  avoid  if  possible  polypharmacy, 
so  that  if  unmistakable  results  follow  the  administration  of  drugs, 
we  may  know  to  which  one  the  credit  is  due.  Let  us  no  longer 
prescribe  calomel,  iron,  cinchona,  and  whisky  in  pyemia  and 
kindred  disorders,  and  claim  wonderful  results  for  the  calomel. 

In  our  individual  capacities  our  organization  must  be  sustained 
by  our  unstinted  effort  and  influence.  Let  us  cherish  a  determi¬ 
nation  to  contribute  something  to  the  general  fund  of  knowledge 
at  every  one  of  its  meetings.  As  much  as  possible  let  that  some¬ 
thing  be  selected  from  our  own  observation  of  diseases,  and  from 
notes  made  at  the  time  of  the  observation.  In  all  our  investiga¬ 
tions  let  us  be  f* content  trustfully  to  follow  the  evidence  whither¬ 
soever  it  leads.”  Let  us  cultivate  independence  of  thought  and 
action  ;  let  us  accept  nothing  as  truth  upon  authority  alone,  but 
apply  the  test  of  individual  reason  and  judgment  to  every  dictum, 
no  matter  from  what  source  it  may  be.  Let  us  see  for  ourselves 
that  a  proposition  is  true,  before  we  accept  it  as  truth ;  and  as 
sedulously  let  us  guard  against  our  proneness  to  condemn  as 
physiologically  or  pathologically  absurd  any  statement,  however 
unpretending  or  obscure  its  source,  without  the  most  careful  and 
impartial  examination.  Prof.  Tyndall  says  of  inductive  inquiry, 
u it  requires  patient  industry  and  an  humble  and  conscientious 
acceptance  of  what  nature  reveals.  The  first  condition  of  success 
is  an  honest  receptivity  and  a  willingness  to  abandon  all  precon¬ 
ceived  notions,  however  cherished,  if  they  be  found  to  contradict 
the  truth.  Believe  me,  a  self-renunciation  which  has  something 
noble  in  it,  and  of  which  the  world  never  hears,  is  often  enacted 
in  the  private  experience  of  the  true  votary  of  science  !  ” 

I  trust  we  all  may  become  true  votaries  of  science — and  let 
us  remember,  while  it  may  not  be  possible  for  ns  to  lind  some- 


Annual  Address. 


07 
O  i 


ling  new  m  our  field  of  inquiry,  it  is  yet  “  the  highest  function 

of  intellect  to  co-ordinate  and  bind  together  the  isolated  and 

fragmentary  parts  ”  of  knowledge,  which  lie  scattered  by  the  way- 
side  of  progress. 

In  nil  our  actions  let  us  have  some  other  motive,  than  mere 
self-glorification  to  direct  us.  Let  us  avoid  even  the  appearance 
of  obscuring  the  just  prominence  of  any  brother;  no  man's  career 
however  brilliant,  or  eminence  however  dazzling,  can  furnish  a 
warrant  for  depreciating  the  merits  of  the  humblest  worker  in 
our  ranks.  Let  us  cultivate  in  ourselves  the  quality,  fa  manliness 
unfortunately  so  rare,]  of  honestly  relying  on  our  own  merits  for 
our  position  in  the  public  esteem.  A  manliness  independent  of 
the  whims  and  caprices  of  interested  friendship;  a  manliness 
which  supplies  the  readiness  for  every  emergency,  and  brings  out 
every  energy  when  it  is  needed,  which  would  not  allow  us  to  view 
our  own  errors  and  failings  with  indulgence,  and  visit  those  of 
others  with  unsparing  reprehension. 

I  hen  let  us  hope  the  Eastern  Medical  Association  is  the  germ 
under  whose  “directive  agency  *’  the  medical  resources  of  Eastern 
North  Carolina,  are  to  be  developed.  That  the  “  constructive 
action  ”  now  going  on  in  our  body  may  be  elaborated  and  multi¬ 
plied,  till  it  shall  manifest  itself  in  every  nook  and  corner  of  our 
State.  That  we  may  yet  breathe  an  atmosphere  so  filled  with  the 
infection  of  medical  progress  that  no  one  of  us  shall  escape  its 
influence.  That  the  work  which  is  ours  of  necessity,  may  be  done 
cheerfully  in  the  faith  that  though  our  highest  aims  be  not  ac¬ 
complished,  good  results  must  come  to  a  determined  aud  manly 
effort. 

‘Herbert  Spencer  has  said,  “there  is  perhaps  not  a  subject  to 
which  men  devote  attention,  that  has  not  some  value,”  and  with 
equal  justice  may  it  be  said  every  effort  made  to  clear  up  unknown 
or  imperfectly  understood  phenomena,  has  its  value;  for  if  noth¬ 
ing  more  be  accomplished  it  will  at  least  show  to  the  future  ad¬ 
venturer  in  the  same  domain  that  this  way  or  that,  will  not  lead 
to  the  goal  for  which  he  strives,  and  thereby  induce  him  to  take 

another  direction  for  its  attainment. 

Let  us  attend  punctually  the  meetings  of  our  Association? 
bringing  whatever  of  “  enlightening  facts  we  may  havegatheicd 
on  our  way;  but  whether  we  have  anything  to  biing  oi  not,  lit 

•J  ' 


38 


Hyatt’s  Paper 


ns  come,  ever  remembering  our  most  punctual  attendants  are  the 
busiest  practitioners.  Let  us  come  for  a  draught  fresh  from  the 
fountain  of  progress.  Let  ns  come  to  renew  our  vows  of  contin¬ 
ued  and  increased  effort  for  the  advancement  of  our  science, 
never  ceasing  in  our  efforts  till  the  necessity,  which  called  into 
existence  our  Association,  itself  shall  have  ceased  to  exist. 

(Appendix  B.) 

Fifteen  Uses  for  the  Indiarubber  Condom. 

By  H.  Otis  Hyatt,  Kinston,  N.  C. 

Mr.  President  and  Gentlemen  of  the  Eastern  (N.  C.) 

Medical  Association  : 

Permit  me  to  call  your  attention  to  fifteen  uses  for  the  condom 
or  so  called  male  safe.  The  condom,  as  you  are  aware,  was 
originally  designed  as  a  means  of  preventing  conception,  and 
as  a  protection  against  venereal  diseases.  The  use  of  it  for  anti¬ 
conception  purposes  has  no  doubt  caused  a  great  deal  of  suffer¬ 
ing  among  women,  producing  cervicitis,  and  a  long  train  of  ner¬ 
vous  ills.  It  acts  as  a  dark  impenetrable  veil  that  shields  the 
infamy  of  those  whom  we  often  believe  pure,  and  as  a  source  of 
temptation,  to  those  who,  are  lacivious,  to  sin  without  fear  of 
detection.  Its  evils  are  great;  but  every  cloud  has  its  silver 
lining,  and  every  evil  its  good,  so  I  hope  to  show  you  that  even 
the  condom,  may  often  be  turned  to  good  account. 

First :  As  a  means  of  applying  heat  or  cold  to  inflamed  sur- 
faces^filled  with  ice,  and  the  end  tied,  it  will  be  found  a  most 
useful  application  to  an  inflamed  eye,  or  the  fore-head  of  a  fever 
patient. 

Second:  To  arrest  bleeding  from  the  nose,  which  it  will  do  as 
effectually  as  plugging  by  Bellocq’s  canula  or  by  the  insufflation 
of  the  persulphate  of  Iron.  To  do  this  a  small  size  condom  is 
tied  over  the  end  of  a  Davidson’s  syringe  nozzle  near  its  point? 
the  pendant  or  baggy  portion  is  pushed  into  the  nose,  as  far  back 
as  the  posterior  nares;  it  is  then  filled  with  water  which  causes 
it  to  expand  in  all  possible  directions,  and  to  fill  up  the  entire 
nasal  cavity,  producing  an  arrest  of  haemorrhage  by  direct  pres¬ 
sure  upon  the  bleeding  surfaces.  A  cord  is  now  securely  tied 


Hyatt’s  Paper 


39 


around  the  condom 
which  it  is  liberated, 
desirable. 


just  anterior  to  the  syringe  nozzle 
It  can  remain  in  the  nose  as  long 


from 
as  is 


I  hn  a.  I  hree  large  condoms  filled  with  ice,  and  placed  one 
above  the  other,  will  answer  the  purpose  of  a  spinal  ice  bag,  or 
filled  with  hot  water  and  placed  up  and  down  the  spine,  a  most 
useful  and  reliable  means  of  arresting  uterine  haemorrhage.  1 
have  frequently  arrested  haemorrhage  from  the  non-pregnant 
uterus  by  the  application  of  heat  to  the  spine,  after  the  failure  of 
large  doses  of  ergot,  and  of  quinine,  I  may  here  remark  that  I 
have  frequently  given  large  doses  of  quinine  alone  for  the  arrest 
of  uterine  haemorrhage  and  have  never  yet  seen  any  appreciable 
decrease  of  the  flow  from  its  use.  Neither  do  I  believe  it  has  any 
effect  on  the  pregnant  uterus  unless  given  in  doses  sufficiently 


large  to  severely  irritate  the  kidneys  and  bladder. 

It  is  true  that  we  sometimes  see  women  abort  after  taking 
quinine  for  the  cure  of  malarial  fever;  but  here  we  are  in  danger 
of  mistaking  a  post  hoc,  for  a  propter  hoc.  It  is  well  known 
that  chill  and  fever  will,  unless  promptly  arrested,  frequently 
produce  abortion.  Within  the  last  two  weeks  I  have  arrested  a 
threatened  abortion,  produced  by  malarial  fever,  by  the  prompt 
exhibition  of  quinine  ;  and  that  too  without  combining  it  with 
morphine;  and  in  those  cases,  if  any  such  occur,  in  which  there 
is  no  element  of  malarial  disease,  and  abortion  follows  the  exhi¬ 
bition  of  quinine,  it  seems  as  if  it  might  be  ascribed  to  the  indi¬ 
vidual  peculiarity.  On  one  occasion  I  gave  to  a  pregnant  woman 
forty  seven  grains  of  quinine  for  the  cure  of  neuralgia,  without 
its  producing  any  ill  effects.  Heat  to  the  spine  seems  to  produce 
contraction  of  the  smaller  vessels  of  the  lower  extremities  and 
pelvic  viscera,  causing  a  sensation  of  cold  of  which  patients  fre¬ 
quently  complain.  I  am  indebted  to  Dr.  C has.  Duffy,  Jr.,  for  the 
idea  of  applying  heat  to  the  spine  for  the  arrest  of  uterine 
haemorrhage. 


Fourth:  A  condom  tied  over  the  female  nozzle  of  a  Davidson 
syringe  can  be  used  for  dilating  the  female  urethra.  I  he  nozzle 
covered  by  the  condom,  is  passed  into  the  urethra,  until  one-half 
is  in  the  bladder,  while  the  other  is  outside.  It  is  then  gradually 
pumped  full  of  water  until  the  urethra  is  stretched  to  the  desired 

extent. 


40 


Hyatt’s  Paper 


Fifth:  As  a  vaginal  tampon,  the  end  of  the  condom  is  first 
carried  up  to  the  fornix  vagi  use  and  then  packed  full  of  old  rags, 
sponge,  or  any  tiling  convenient.  Or  it  can  be  stretched  over  a 
cylindrical  speculum  and  packed  through  the  speculum,  after  the 
method  of  Scanzoni.  The  advantages  of  a  condom  as  a  tampon 
are  manifold.  It  is  cleanly,  being  water  proof,  none  of  its  con¬ 
tents  get  soiled.  It  will  admit  of  any  amount  of  packing  with¬ 
out  causing  the  woman  pain.  It  can  be  easily  withdrawn  by  first 
pulling  out  its  contents. 

Sixth:  As  a  means  of  applying  ice  to  the  vagina,  the  condom 
is  introduced  as  for  tamponing,  and  then  tilled  with  ice  and  the 
end  securely  tied,  and  no  dribbling  takes  place.  Is  can  be  easily 
removed  after  the  ice  melts,  emptied  and, is  again  ready  for  use. 

Seventh  :  As  a  means  of  applying  ice  to  the  cavity  of  the  uterus 
for  the  arrest  of  post  partum  haemorrhage— the  condom  is  first 
tilled  with  ice,  tied  well,  oiled,  and  passed  into  the  cavity  of  the 
uterus.  As  many  may  he  used  as  necessary. 

Eighth  :  As  a  means  of  arresting  post  partem  haemorrhage — for 
this  purpose  the  condom,  or  what  is  better  as  it  admits  of  very 
great  distension,  an  india  rubber  balloon  (which  can  be  bought 
at  any  toy  shop,)  is  tied  over  theend  of  a  Davidson  syringe  nozzle, 
and  passed  into  the  cavity  of  the  flacid  uterus.  It  is  then  dis¬ 
tended  with  warm  or  cold  water.  By  this  means  we  bring  pres¬ 
sure  directly  to  bear  upon  the  mouths  of  the  bleeding  vessels, 
which  effectually  closes  them.  It  might  be  objected  to  this 
method,  that  after  the  uterus  is  distended  it  might  refuse  to  con¬ 
tract.  But  this  seems  hardly  probable,  and  even  should  such  an 
event  occur,  after  the  woman  has  rallied,  we  can  administer  ergot 
in  sufficient  doses  to  produce  contractions.  As  soon  as  the  dis¬ 
tention  required  to  check  the  haemorrhage  is  reached,  we  then 
pull  the  tube  from  the  syringe  bulb  and  compress  it  firmly  be¬ 
tween  the  thumb  and  forefinger.  By  so  doing  we  have  perfect 
control  of  the  water  in  the  balloon,  and  can  allow  it  to  escape 
paripasu  with  the  uterine  contractions. 

Ninth  :  As  a  uterine  dilator,  three  or  four  condoms  are  passed 
one  into  the  other,  and  then  fastened  over  the  female  nozzle  of  a 
Davidson  syringe.  Thus  prepared  the  nozzle  is  passed  through 
the  os,  until  one-half  is  in  the  cavity  of  the  uterus,  it  is  then  held 
in  position  while  water  is  pumped  into  the  condoms  until  the 


Hyatt's  Paper 


41 


requisite  amount  of  distension  is  reached.  It  has  the  advantage 
over  other  uterine  dilators,  that  it  is  easier  to  introduce,  while  its 
distensile  power  is  equally  as  great. 

Tenth  :  As  a  means  of  applying  ice  to  the  rectum. 

Eleventh  :  As  a  means  of  arresting  haemorrhage  from  the  rectum 
—  the  condom  and  syringe  are  used  just  as  the  syringe  and  bal¬ 
loon  are,  for  the  arrest  of  uterine  haemorrhage. 

Twelfth  :  As  a  rectal  stricture  dilator — whenever  we  wish  to 
improvise  a  dilator,  either  for  the  gradual  dilitation,  or  forcible 
rupture  of  rectal  stricture,  we  pass  half  a  dozen  condoms  one  into 
the  other,  and  fasten  them  over  the  female  nozzle,  pulling  them 
lengthwise,  so  as  to  cause  them  to  lay  close  to  the  nozzle.  It  is 
best  in  such  cases  to  perforate  the  syringe  nozzle  midway  between 
the  point  and  screw  end.  If  this  be  neglected  difficulty  will  some¬ 
times  ce  found  to  the  free  sntrance  of  water  into  the  condom,  on 
account  of  closure  of  the  end  of  the  nozzle  by  the  tense  rubber 
drawn  over  its  point.  The  dilator  thus  prepared  is  passed  half 
way  through  the  stricture  and  gradually  filled  with  water,  until 
the  stricture  is  sufficiently  dilated  or  forcibly  ruptured.  If  the 
condoms,  as  soon  as  they  begin  to  fill,  should  slip  through  the 
stricture  up  the  bowel,  as  they  will  often  do,  if  the  stricture  is 
within  an  inch  or  two  of  the  anus,  we  can  continue  to  fill  them, 
and  as  soon  as  they  attain  the  size  of  a  large  man’s  wrist,  we  can 
pull  them  through  the  stricture  and  dilate  it  by  this  means 
equally  as  well  as  if  they  had  remained  in  situ.  The  sphincter 
ani  can  be  over  distended,  and  paralized  by  the  same  method. 

Thirteenth:  As  a  means  of  constant  pressure  for  the  cure  of 
orchitis — the  condom  is  slipped  over  the  swollen  testicle,  and 
allowed,  to  remain  until  the  cure  is  effected.  For  this  suggestion 
[  am  indebted  to  Dr.  Black  of  Fort  Wayne,  Ind.  (See  American 
Medical  Weekly ,  Sept.  5th,  1874).  His  method  of  applying  it  is 
by  folding  the  condom  back  upon  itself,  after  the  manner  of  the 
inverted  finger  of  a  glove,  and  turning  it  over  the  inflamed  testi¬ 
cle  just  as  a  tight  sock  is  turned  on  the  foot.  But  by  whatever 
method  you  try  to  put  it  on  you  will  find  it  difficult. 

Fourteenth  :  As  a  syringe  the  condom  is  first  filled  with  water, 
and  a  reed  tied  into  the  mouth  of  it.  We  thus  have  a  syringe 
after  the  old  style  reed,  and  pig’s  bladder. 

Fifteenth  :  The  syringe,  and  condoms,  prepared  as  for  dilating 


42 


Attmoke’s  Paper. 


rectal  stricture,  can  be  used  for  dilating  the  wound  made  in 
median  or  lateral  lithotomy,  or  instead  of  Dolbeau’s  dilator  in 
cases  of  perineal  lithotrity. 

(Appendix  C.) 

Acute  Aural  Catarrh. 

By  Geoege  S.  Attmore,  M.  D.,  Newbeen,  N.  C. 

Mr.  President  and  Gentlemen  : 

Having  been  appointed  at  our  last  meeting  to  read  an  essay 
upon  Aural  Catarrh,  and  not  having  been  limited  to  any  particu¬ 
lar  form  of  this  malady,  and  owing  to  the  short  time  allotted  each 
individual  member,  in  which  to  dispose  of  his  subject,  I  have  con¬ 
cluded  to  confine  my  remarks,  entirely  to  that  form  of  aural  dis¬ 
ease,  known  among  nosologists  as  Acute  Aural  Catarrh.  By 
Acute  Aural  Catarrh,  I  mean  that  condition  in  which  the  mucous 
membrane  lining  the  middle  ear  is  in  a  state  of  acute  inflamma¬ 
tion,  which  runs  a  rapid  course,  ending  either  in  resolution  or 
acute  suppuration.  In  order  fully  to  understand  and  compre¬ 
hend  our  subject,  it  is  necessary  that  we  should  take  a  cursory 
glance  at  the  anatomy  and  physiology  of  the  parts  involved  in 
the  morbid  process. 

The  following  I  have  condensed  from  Marshall’s  Ontlines  of 
Physiology,  and  I  think  that  in  it  will  be  found  a  sufficient 
knowledge  of  the  parts  in  question  : 

“The  middle  ear  or  tympanum,  is  a  small  cavity,  or  chamber, 
in  the  temporal  bone,  containing  air,  and  certain  small  bones, 
named  the  ossicles  of  the  ear,  and  a  few  muscles  and  nerves;  it 
is  placed  between  the  membrana  tympani,  and  the  outer  wall  of 
the  labyrinth.  Its  outer  boundary  is  formed  bv  the  membrana 
tympani;  this  is  a  thin  semi-transparent  membrane,  of  an  oval 
shape,  which  slopes  from  above,  downwards  and  inwards,  and 
from  behind,  forwards  and  inwards,  and  is  fixed  by  its  circum¬ 
ference  to  a  slight  groove  in  the  bone.  It  is  the  resemblance  of 
this  membrane  to  the  head  of  a  drum  that  has  given  the  name  of 
drum  of  the  ear,  or  tympanum,  to  the  middle  ear. 

This  membrane  is  composed  of  three  layers;  an  outer  one, 
which  is  an  extension  of  the  skin  lining  the  external  meatus,  an 


Attmores  Paper 


43 


inner  lajer,  similarly  derived  lrom  the  mucous  membrane  lining 
the  tympanum,  and  an  intermediate  layer,  consisting  of  fibrous 
and  elastic  tissue,  in  which  are  blood-vessels  and  nerves:  the  mid¬ 
dle  layer  is  said  to  consist  of  two  lamina,  the  outer  of  which  is 
composed  of  radiating,  and  the  inner  of  annular  fibres.  (Toynbee.) 

I  he  inner  wall  of  the  tympanic  cavity  corresponds  with  the 
outer  surface  of  the  labyrinth. 

The  tympanum  communicates,  behind  and  above,  with  cells  in 
the  mastoid  process  of  the  temporal  bone,  called  the  mastoid  cells  • 
in  front  and  below,  it  opens  into  the  eustachian  tube,  a  trumpet¬ 
shaped  canal,  partly  osseous,  partly  cartilaginous,  leading  into  the 
upper  part  of  the  pharynx. 

There  are  also  several  small  apertures,  for  the  passage  of  vessels, 
uerves,  and  minute  muscles. 

The  little  bones,  or  ossicles  of  the  ear,  the  smallest  in  the  body, 
are  three  in  number,  they  are  stretched  across  the  tympanic 
cavity;  from  the  membrane  tympani  to  the  inner  wall  of  that 
chamber,  and  are  named,  the  malleus,  the  incus,  and  the  stapes. 
The  malleus,  or  hammer  like  bone,  is  attached,  by  a  somewhat 
twisted  process,  called  its  handle,  to  the  inner  surface  of  the 
membrana  tympani,  near  its  centre  ;  this  attachment  of  the  bone 
causes  the  membrane  to  be  drawn  in,  as  it  were,  towards  the 
tympanum  another  long  and  delicate  process,  called  the  proces¬ 
sus  gracilis,  descends  to  the  floor  of  the  tympanum;  while  its 
rounded  part,  or  head,  which  is  also  somewhat  fixed  to  the  roof 
of  that  cavity,  is  articulated  with  a  concave  surface,  on  the  thick 
part  of  the  incus.  The  incus,  or  anvil  like  bone,  consists  of  a 
massive  part  or  body,  and  of  two  processes,  or  legs,  being  shaped 
somewhat  like  a  double  tooth.  Besides  being  articulated  with 
the  malleus,  the  incus  is  attached,  by  its  shorter  leg,  to  the  hin¬ 
der  wall  of  the  tympanum  :  by  its  long  leg,  it  is  articulated  with 
the  third  ossicle  or  stapes,  which  is  the  innermost  of  the  three 
bones,  by  a  little  tubercle  named  the  orbicular  bone,  which  is 
sometimes  regarded  as  a  separate  bone. 

The  stapes,  so  named  from  its  resemblance  to  a  stirrup,  is 
placed  horizontally,  and  is  attached,  by  its  foot-piece  or  base,  to 
the  inner  wall  of  the  tympanum  when  it  is  fixed,  by  fibrous  mem¬ 
brane,  to  the  margin  of  an  oval  aperture  in  the  bone,  called  the 
fenestrum  ovalis,  leading  into  the  labyrinth  :  it  is  so  attached  as  to 


44 


Attmore’s  Paper. 


be  able  to  undergo  certain  movements.  The  foot-hole  in  this 
diminutive  stirrup,  is  closed  by  a  membrane  in  its  perfect  state. 

These  little  bones,  which  weigh  only  a  few  grains,  are  covered 
with  periosteum,  supplied  with  blood-vessels,  articulated  together 
by  perfectly  movable  joints,  and  provided  with  minute  muscles, 
which,  acting  on  the  small  levers  formed  by  this  jointed  rod, 
influence  the  condition  of  the  membrana  tympani  on  the  one 
hand,  and  of  the  fibrous  membrana  uniting  the  base  of  the  stapes 
to  the  margin  of  the  fenestra  ovalis,  on  the  other. 

The  conjoined  bones  rotate  upon  a  horizontal  axis,  passing 
through  the  slender  process  of  the  malleus,  the  head  of  that  bone, 
and  the  body  and  short  process  of  the  incus. 

The  muscles  of  the  tympanum  are,  like  the  bones,  three  in 
number.  Two  of  these,  the  tensor  tympani,  and  the  so-called 
laxator  tympani,  arise  from  definite  points  of  the  surrounding 
petrous  bone,  and  are  inserted  into  the  malleus;  the  first  named 
is  undoubtedly  muscular,  and  draws  the  membrana  tympani  in¬ 
wards,  and  tightens  it;  the  latter  was  formerly  described  as  a 
muscle  having  the  opposite  action,  but  it  is  either  seldom  present, 
or  as  maintained  by  some  authorities,  is  merely  a  reddish  liga¬ 
mentous  structure.  The  tensor  tympani  muscle,  according  to 
Toynbee,  is  inclosed  in  a  tubular  ligament,  which,  he  supposed, 
keeps  the  tympanum  in  a  state  of  medium  tension,  the  tensor 
tympani  only  being  called  into  play  when  the  tension  of  the 
membrane  is  increased. 

When  the  tensor  tympani  acts,  the  head  of  the  long  leg  of  the 
incus  is  drawn  inwards,  so  that  the  base  of  the  stapes,  which  is 
articulated  with  it,  must  also  advance  towards  the  inner  wall  of 
the  tympanum,  and  so  press  in  the  membrane  of  the  fenestra 
ovalis.  Tick  has  proved  this  bv  direct  observation. 

The  third  muscle,  called  the  stapedius,  is  inserted  into  the 
stapes  ;  it  is  generally  regarded  as  a  tensor  of  the  membrane  of 
the  fenestra  ovalis,  but,  by  some  it  has  been  described  as  relaxing 
that  membrane.  It  is  the  smallest  muscle  in  the  body. 

The  tensor  tympani  is  supplied  by  a  nerve  from  the  otic  gang¬ 
lion,  the  laxator,  it  is  said,  by  the  chorda  tympani  nerve,  and  the 
stapedius  by  a  branch  of  the  facial  nerve.  Below  and  rather  be¬ 
hind  the  fenestra  ovalis,  on  the  inner  wall  of  the  tympanum,  is 
another  small  rounded  opening  in  the  bone,  called  the  fenestra 


Attmore’s  Paper 


45 


lotuncla;  it  is  closed  in  the  recent  state,  by  a  membrane. 

Ihe  mucous  membrane  lining  the  tympanum  is  thin,  and  for 
the  most  part,  covered  with  ciliated  epithelium  ;  it  assists  in  clos¬ 
ing  the  two  fenestras,  and  serves  to  form  the  inner  layer  of  the 
membrana  tympaui. 

In  the  latter  situation,  it  is  said  to  be  destitute  of  cilia,  lastly, 
n  is  reflected  over  the  little  ossicles,  and  the  tendons  of  their 
muscles,  and  also  over  the  chorda  tympani  nerve,  which  traverses 
the  tympanum. 

It  contains  no  mucous  glands,  but  is  constantly  moistened  with 
a  yellowish  fluid. 

In  front,  it  is  continuous  with  the  ciliated  mucous  membrane 
lining  the  eustachian  tube,  and  through  it,  with  that  of  the 
upper  part  of  the  pharynx;  behind  it  enters  and  lines  the  mas¬ 
toid  cells.” 

And  now,  gentlemen,  having  shown  you  the  topography,  of 
the  tissues  involved  in  this  painful  affection;  I  ask  you  to  bear 
with  me  patiently,  while  I  endeavor  to  give  some  idea  of  the  in¬ 
tensity  and  extent,  to  which,  this  morbid  process  may  obtain. 

Starting  either  in  the  eustachian  tube,  its  pharyngeal  extremi¬ 
ty,  or  in  the  meatus  auditorius  externus,  the  inflammation  travels, 
by  contiguity  of  tissue,  with  almost  lightning  like  rapidity  into 
and  over  the  whole  mucous  membrane  of  the  middle  ear,  and  in 
bad  cases  even  into  the  mastoid  cells  themselves,  exudation  tak¬ 
ing  place  the  whole  cavity  is  filled  with  mucus,  and  not  only  the 
cavity;  but  fluid  is  poured  out  into  the  cellular  tissue,  lying  be¬ 
tween  this  membrane  and  the  periostium,  hence  the  great 
amount  of  pain,  likened  by  Yon  Trotsch  to  that  of  a  periostitis. 

Those  of  you  who  have  ever  suffered  from  the  common  ear¬ 
ache  of  oldern  times,  and  this  is  nothing  else,  will  bear  me  out  in 
the  assertion,  that  of  all  aches,  this  is  the  most  painful,  often 
causing  the  patient,  however  stoical  he  may  be,  to  cry  aloud  in 
his  anguish.  And  if  such  be  the  suffering  of  grown  men  and 
women,  what  must  be  the  agony  of  the  little  child  who  is  so  often 
brought  to  us  with  this  terrible  disease  ?  Those  of  us  who  have 
suffered  ourselves,  alone  know  how  to  sympathize  with  the  little 
sufferer  as  he  cries  aloud,  “  my  head  !  oh,  my  head!  "  And  yet, 
how  often  are  just  such  patients  dismissed  with  the  assurance 
that  it  is  only  an  ear-ache,  that  it  will  amount  to  nothing;  and 


40 


Attmore’s  Paper. 


without  the  semblance  of  an  examination  into  the  cause  of  the 
pain,  directed  to  go  home  and  drop  sweet-oil  and  laudanum  in 
the  ear,  and  apply  a  poultice  to  the  outside  of  it,  with  just  as 
much  gravity  and  dignity,  as  if  they  were  really  going  to  do  any 
good. 

Gentlemen,  truly,  if  this  is  all  that  we  can  do  for  our  suffering 
patients,  it  behooves  us,  as  humanitarians  as  well  as  physicians, 
to  investigate  closely  this  morbid  process,  and  to  devise  something 
in  the  shape  of  treatment  that  will  at  least  have  the  merit  of 
doing  them  no  harm,  if  it  can  do  them  no  good. 

I  am  happy  to  state,  however,  that  within  the  last  decade  and 
that  also  preceding  it,  that  a  great  deal  has  been  done,  towards 
elucidating  the  diseases  of  the  auditory  apparatus.  Patient  and 
diligent  research  has  been  made,  and  the  fruits  of  it  are  visible, 
in  the  increased  facilities  for  diagnosing  and  treating  the  diseases 
of  this  important  structure,  and  in  the  increased  knowledge  we 
now  possess,  of  its  anatomy,  physiology  and  pathology ;  and  ere 
long  the  expression,  “  we  can  do  nothing  for  it,  you  had  better  let 
it  alone,’  will  be  as  rare  as  it  is  now  common,  and  we  will  no 
longer  trust  to  our  patients  out-growing  a  disease  that  may  result 
in  his  death  if  neglected,  or  eventuate  in  chronic  suppuration 
with  all  its  attendant  evils. 

If  we  were  to  form  our  estimate  of  the  frequency  of  this  disease, 
from  the  statistical  tables  of  most  writers  upon  the  subject,  we 
should  have  a  very  erroneous  opinion,  of  the  number  of  cases 
that  actually  occur  in  practice. 

ihus  Prof.  Chisolm,  in  his  report  of  the  Baltimore  Eye  and 
Ear  Institute  lor  1874,  only  records  eleven  cases  of  acute  catarrh 
out  of  542  cases  of  ear  disease  that  presented  themselves  for  treat¬ 
ment  at  that  institution,  from  Sept.  1st,  1872  to  Nov.  1st,  1873, 
inclusive.  Roosa  reports,  from  statistics  of  private  practice,  only 
fifty-five  cases  out  of  994  cases  of  aural  disease  treated  by  him. 

Judging  from  the  above,  we  would  be  led  to  think  that  acute 
aural  catarrh  was  a  rare  disease,  when  on  the  contrary  it  is  one 
of  the  most  frequent  of  all  diseases.  There  are  very  few  people 
I  imagine  who  have  not,  at  one  time  or  another  in  their  lives, 
suffered  from  so-called  ear-ache,  and  acute  aural  catarrh  is  nothing 
else,  but  the  old  time  and  oft  neglected  ear-ache. 

Roosa  says  in  regard  to  this  matter,  “  Every  physician  will  at 


4? 


Att more’s  Paper. 


once  recall  the  fact,  that  it  is  often  incidentally  mentioned,  when 
perhaps  he  is  visiting  a  patient  suffering  from  other  diseases,  that 
Johnnie  or  Mary  has  had  a  severe  earache  all  night,  and  that 
there  has  been  great  difficulty  in  quieting  the  fearful  pain.  Very 
often  indeed  the  fact  will  be  added,  that  the  pain  is  not  yet  sub¬ 
dued,  and  that  the  family  have  exhausted  the  means  at  their  dis¬ 
posal  for  relieving  it ;  and  yet,  taught  by  tradition  and  experi¬ 
ence,  they  do  not  expect  any  thing  from  the  physician,  whose  aid 


becomes  so  efficacious  for  the  pain  of  colic  or  of  peritonitis. 

It  is  to  be  feared  that  many  physicians  stand  helplessly  by,  and 
allow  an  acute  catarrh  of  the  middle  ear  to  run  on  to  suppuration 
of  the  drum-head  or  to  meningitis,  without  an  attempt  at 
interference.” 


I  hope  to  be  able,  before  closing  this  article,  to  show,  that  we 
have  sufficient  means  at  our  disposal,  not  only  for  diagnosing  but 
also  for  curing  this  disease,  and  I  wish  to  impress,  once  more? 
upon  the  minds  of  my  hearers,  the  fact,  that  the  disease  begins 
as  the  common  ear-ache,  and  that  a  large  percentage  of  cases  of 
ear  ache,  have  their  causation  in  acute  aural  catarrh. 

It  will  be  seen  therefore,  that  instead  of  being  an  inflammation 
that  we  can  trust  to  its  natural  tendency  to  get  well? 
it  is  one  that  requires  our  closest  attention,  and  that  we 
are  dealing  with  the  history  of  a  disease  that  it  behooves  the  phy¬ 
sician  to  master  most  thoroughly. 

The  symptoms  may  be  divided  into  those  which  are  subjective 
and  those  that  are  objective: 

The  Subjective  Symptoms  are — Pain  in  depth  of  Ear,  A  sense 
of  fullness,  Noises  in  the  Ear. 

-  The  Objective  Symptoms  are — Vascular  Injection,  Bulging 
outwards  of  Membrana  Tympani,  Impairment  of  hearing,  Catarrh 
of  Eustachian  Tube  and  Pharynx,  Fever. 

The  first  is  pain,  this  may  be  severe  or  mild  :  ordinarily  how¬ 
ever  the  patient  experiences  a  pain  that  is  very  acute  and  at  the 
same  time  penetrating,  sometimes  so  much  so,  that  he  will  declare 
he  has  a  neuralgia  and  indeed  it  is  often  very  difficult  to  distin¬ 
guish  this  pain  from  neuralgia  of  the  molar  teeth  so  closely  does 
it  resemble  that  malady,  more  frequently  however  the  pain  is  ac¬ 
companied  by  a  feeling  peculiar  to  this  distressing  complaint, 
described  if  the  patient  is  old  enough,  as  a  feeling  of  fullness  in 


48 


Attmore’s  Paper. 


the  tern  pero- maxi  lary  region,  accompanied  by  one  of  emptiness 
and  lightness  of  the  head  and  a  feeling  of  utter  helplessness  and 
distress. 

In  children  this  last  will  be  found  to  be  their  chief  trouble,  and 
if  of  sufficient  age  they  will  cry  out  and  carry  their  hands  to  the 
head,  and  beseech  the  bystanders  for  relief.  In  young  infants 
who  cannot  make  known  their  sufferings  by  speech,  we  will  ob¬ 
serve  a  peculiar  distressing  cry  and  an  effort  to  get  their  heads 
down  upon  something  to  rest  them,  and  a  continuous  disposition 
to  place  the  hands  on  the  head. 

Another  very  distressing  and  important  symptom  in  those 
who  are  able  to  give  utterance  to  their  sensations,  is  that  of  noises 
in  the  ear,  compared  by  patients  to  those  sounds,  with  which,  they 
are  most  familiar,  such  as,  ringing  of  bells,  the  roaring  of  the  surf? 
often  to  the  noise  occasioned  by  machinery  in  motion,  as  the 
threshing  machine,  &c.  All  patients  do  not  complain  of  these 
symptoms  in  an  equal  degree,  some  will  complain  of  one,  some  of 
another,  but  most  always  upon  questioning  them  closely,  we  will 
find  that  all  can  be  elicited. 

We  now  come  to  the  more  important,  or  objective  symptoms: 
upon  examination,  we  will  find  more  or  less  vascular  injection  of 
the  bottom  of  the  meatus  auditorius  extern  us,  and  of  the  drum¬ 
head,  sometimes  confined  to  the  peripheries  of  the  membrane,  at 
others,  completely  involving  this  structure  and  the  surrounding 
parts:  very  frequently  we  shall  find  vessels  developed  in  it,  and 
then  it  loses  its  translucent  appearance,  and  seems  to  be,  an  in¬ 
tensely  redened  septum,  hard  to  distinguish  from  the  parts  around 
it. 

frequently  the  membrane  will  appear,  as  though  there  were 
something  behind  it,  causing  it  to  have  a  bulging  appearance, 
with  the  convexity  outwards. 

Roosa  says  in  regard  to  this  symptom  :  “  bulging  outwards  of 
the  membrana  tympani  is  a  symptom  that  may  often  be  observed 
alter  the  first  48  hours  of  an  attack  of  Acute  Aural  Catarrh. 

If  the  disease  continue  longer  in  an  acute  form,  spontaneous 
perforation  is  apt  to,  but  does  not  always  occur. 

This  bulging  outwards,  I  have  most  frequently  observed  in  the 
posterior  and  inferior  quadrant,  but  also  in  Shrapnel’s  membrane, 
and  usually  in  the  posterior  portion  of  the  membrane. 


Attmore’s  Paper. 


49 


It  is  sufficiently  marked  to  he  detected  by  any  one  who  is  at 
all  familiar  with  the  examination  of  the  normal  membrane. 

In  rare  cases,  I  believe  I  have  seen  but  two  in  my  experience — 
the  imperforate  membrana  tympani  will  be  found  to  pulsate  syn¬ 
chronously  with  the  pulsations  of  the  heart. 

As  is  well  known,  it  is  quite  common  to  observe  a  pulsation  of 
of  the  vessels  of  the  cavity  of  the  tympanum  in  cases  of  acute 
and  chronic  suppuration  of  the  part,  but  pulsation  of  the  imper¬ 
forate  membrana  tympani  is  a  rare  symptom. 

There  must  be  a  great  increase  of  the  tension  of  the  membrane 
when  this  occurs  from  pressure  of  the  blood  column  or  of  mucus 
behind  it. 

Increased  secretion  from  the  pharynx  and  region  of  the  poste¬ 
rior  nares  is  almost  always  observed  in  cases  of  acute  catarrh ; 
but  it  requires  but  a  mere  mention  in  this  place.” 

The  impairment  of  hearing  is  almost  always  found  to  exist, 
sometimes  the  patient  is  as  deaf  as  an  adder,  at  others  the  impair¬ 
ment  is  very  slight,  and  the  patient  will  assure  us  that  he  hears 
very  well;  but  upon  examination  with  the  watch  and  tuning 
fork,  I  think  but  very  few  will  be  found  but  what  show  some  de¬ 
viation  in  this  particular. 

We  will  see  some  few  however,  in  whom  this  sense  is  heightened* 
being  even  more  acute  than  in  health,  and  even  painfully  acute. 

In  acute  catarrh  developed  upon  old  chronic  cases  of  non-sup¬ 
puration,  the  hearing  is  also  morbidly  increased.  Why  there 
should  be  this  difference  I  cannot  tell,  neither  can  I  arrive  at  any 
satisfactory  conclusion  from  the  perusal  of  works  written  especially 
upon  the  ear. 

We  now  come  to  the  most  constant  symptom  fever  or  more 
properly  pyrexia.  This  symptom  will  be  found  to  be  an  invariable 
accompaniment  of  Acute  Aural  Catarrh. 

If  we  apply  the  thermometer,  and  we  should  always  do  it,  we 
will  find  the  temperature  elevated,  more  or  less,  in  all  cases  accord¬ 
ing  to  the  gravity  of  the  attack. 

The  pulse  will  be  found  increased  in  frequency,  the  skin  hot* 
the  face  flushed,  the  eyes  injected,  the  temporal  arteries  and  the 
carotids  throbbing,  and  a  general  appearance  of  distress. 

In  some  cases  we  may  have  delirium  and  somnolence,  and  the 
patient  will  have  the  appearance  of  one  suffering  from  an  inflam- 


50 


Attmore’s  Paper. 

mation  of  the  cerebral  membranes;  particularly  if  lie  be  a  child 
and  the  disease  has  passed  into  suppurative  inflammation. 

And  yet  this  is  the  disease  that  the  practitioner  so  often  dis¬ 
misses  as  trivial,  with  the  assurance  that  the  patient  will  out¬ 
grow  it,  or  for  which  a  simple  poultice  is  prescribed,  which,  in 
my  experience  only  hastens  the  suppurative  stage  and  invites  a 
destruction  of  the  middle  ear.  The  causes  of  the  disease  may  be 
tabulated  according  as  they  affect,  the  inner  or  outer  terminus  of 
the  drum  cavity,  or  in  other  words,  those  causes  that  act  from 
within  and  those  acting  from  without,  thus: 

Causes  acting  from  Without — Cold  applied  to  external  meatus, 
Inflammation  of  external  meatus,  however  caused,  extending 
through  the  tympanic  membrane,  into  the  cavity. 

Causes  acting  from  Within — Cold  affecting  the  throat  and  ori¬ 
fices  of  eustaohian  tubes,  Any  inflammation  of  throat,  however 
caused,  extending  by  conti unity  of  tissue;  under  this  head,  may 
be  included  the  exanthematous  diseases,  measles,  scarlet  fever, 
and  small-pox.  Svphilitie  infection,  also  may  cause  the  disease: 
but  there  seems  to  be  no  diagnostic  differences  in  these  and  other 
cases,  save  their  his  tor  v. 

While  Acute  Aural  Catarrh  mav  have  its  origin  in  the  external 
meatus,  we  more  often  find  it  beginning  in  the  pharyngeal  ex¬ 
tremity7,  and  extending  along  the  eustachian  tube  to  the  drum 
cavity.  Should  we  not  therefore,  in  every  case  of  inflammation  of 
the  throat,  however  caused,  examine  the  patient’s  hearing  power, 
and  if  we  find  this  deficient,  investigate  closely  the  cause  and  if 
we  find  catarrh  of  the  tympanum,  treat  it,  and  not  sit  idlv  by 
and  wait  for  suppuration  to  occur,  particularly  when  our  reme¬ 
dies  cannot,  in  any  manner,  conflict  with  the  treatment  of  the 
pharynx  ? 

the  use  of  the  nasal-douche,  is  said  by  some,  to  cause  the  dis¬ 
ease,  and  though  it  presents  a  most  convenient  means  of  treating 
nasal  catarrh,  yet  upon  authority  of  Roosa.  Moose,  Knapp,  Pardee 
and  other  specialists,  we  must  lay  it  aside.  The  exanthematous 
diseases  will  be  found  to  be,  a  most  fruitful  cause  of  this  malady, 
and  so  will  all  constitutional  diseases  that  affect  the  throat. 

1  neumonia  and  bronchitis,  also  coryza,  often  give  rise  to  the 
disease. 

In  regard  to  diagnosis,  after  what  has  been 


previously  said 


Attmore's  Paper. 


51 


there  remains  little  for  me  to  write:  I  will  content  myself  there- 
h>re  with  a  description  of  the  instruments  more  necessary,  to  aid 
us  to  attain  this  end. 

hirst  we  must  have  an  ear  speculum,  of  which  there  are  various 
paterns,  all  having  for  their  object,  to  straighten  the  auditory 
canal.  I  prefer  the  simple  cone  of  silver  or  hard  rubber,  and 
known  as  Wild's  Speculum,  although  that  of  Weber  is  very  good 
for  the  purpose. 

We  must  then  have  a  mirror  for  reflecting  the  light  into  the 
speculum,  or  we  will  not  be  able  to  see. 

Some  authors  I  know,  among  whom  is  Prof.  Chisolm,  of  Balti¬ 
more,  state  that  by  simply  lifting  the  auricle  upwards  and  back¬ 
wards,  that  sufficient  light  will  enter  the  meatus  for  all  practical 
purposes  ;  but  I  must  confess  that  I  have  never  been  able  to  il¬ 
luminate  the  deep  parts  of  the  passage  in  that  manner.  It  cer¬ 
tainly  requires  a  nice  manipulation  to  effect  it.  I  find  that  my 
head  invariably  intercepts  the  very  ray  of  light,  that  should  pass 
to  the  drum-head. 

But  no  such  difficulty  will  be  encountered  if  we  use  the  mirror: 
this  can  be  used  with  a  handle  or  with  a  head-band,  the  latter 
mode  being  most  convenient,  as  it  leaves  both  hands  free  for  work. 
With  these  instruments  we  will  be  able  to  examine  the  canal  and 
membrana  tympani ;  but  these  are  not  all  we  need,  for  in  order 
to  know  if  the  eustachian  tubes  are  pervious,  we  must  provide 
ourselves  with  a  Politzers  air  bag,  and  an  eustachian  catheter? 
the  former  being  a  small  air  syringe,  with  a  plug  to  fit  the  nose 
or  catheter,  which,  is  a  small  instrument  to  be  used  through  the 
nose  and  inserted  into  the  orifices  of  the  eustachian  tubes, 
through  which,  air  is  forced  into  the  cavity. 

These  latter  instruments  are  of  more  use  in  the  latter  stages  of 
the  disease,  and  serve  materially  to  increase  the  efficacy  of  our 
treatment.  The  prognosis  of  this  disease,  when  taken  in  time  is 
favorable  to  a  cure;  but  when  neglected  and  allowed  to  degen¬ 
erate  into  the  chronic  form  or  any  of  its  sequelae,  it  must  be 
guarded.  In  regard  to  treatment,  Iioosa  says  in  his  book  which 
is  probably  the  latest  work  out  on  ear  disease  and  which  I  regard 
as  the  best  I  have  ever  seen,  The  proper  treatment  of  Acute 
Aural  Catarrh  is  pre-eminently  an  antiphlogistic  one. 

The  disease  is  an  inflammation  of  the  severest  form  and  can 


52 


Attmore's  Paper. 


only  be  combated  by  such  means  as  local  blood-letting  and  opium. 

A  nervous  pain  in  the  ear,  a  true  otalgia  is  a  very  rare  disease. 

In  fifteen  hundred  cases  I  have  seen  but  one  such  affection, 
and  yet  an  inflammation  of  the  middle  ear  is  very  often  treated 
as  would  be  a  case  of  facial  neuralgia;  or  we  might  even  say,  that 
the  ordinary  treatment  of  acute  aural  inflammation  is  pre-emi¬ 
nently  empirical  and  without  reason. 

From  the  time  of  the  ancients  down  to  our  own  day,  all  kinds 
of  decoctions  and  mixtures  have  been  poured  into  the  ear  to  re¬ 
lieve  ear-ache.  Some  of  these  agents  are  of  a  negative  or  slight 
value;  many  of  them  are  of  a  positively  harmful  nature.  To  the 
former  class  belong  such  applications  as  sweet  oil  and  laudanum, 
glycerine,  molasses  and  so  on. 

To  the  other  class  belong  Harlem  oil,  cologne  water,  Ether, 
and  all  stimulating  applications.  Poultices  are  remedies  often 
used,  but  while  they  gene)'  .My  quiet  pain,  their  application  is  so 
dangerous  to  the  integrity  of  the  drum  membrane,  especially  if 
they  be  used  for  many  hours  in  succession,  that  the  practitioner  will 
do  well  to  avoid  them,  unless  other  means  cannot  be  employed 
or  when  the  latter  prove  ineffectual.  In  some  cases  however, 
the  urgency  of  the  pain  will  demand  that  poultices  be  employed. 
The  chief  thing  to  be  done  in  this  disease  is  to  decrease  the  heat, 
swelling  and  vascularity  of  the  parts. 

Applications  of  a  stimulating  nature,  made  to  the  membrana 
tympani,  cannot  do  this,  and  mere  emollients,  such  as  sweet  oil, 
have  a  very  transitory  effect.” 

I  have  quoted  verbatim,  thus  far,  from  this  most  excellent 
work,  in  order  to  show  the  prevalent  opinion  of  the  treatment  to 
be  adopted  in  such  cases. 

The  remedies  that  we  are  taught  to  rely  upon,  in  the  treatment 
of  inflammation,  viz:  blood-letting,  calomel  and  the  use  of  blis¬ 
ters,  I  am  sure  will  not  serve  our  purpose  here. 

Blood-letting  will  be  found  useful,  only  upon  mechanical  prin¬ 
ciples,  by  relieving  the  over-loaded  vessels  and  thus  removing 
piessure ;  and  in  order  to  do  this,  most  effectually,  leeches  may 
be  applied  to  the  part,  the  tragus  being  the  best  point  for  their 
application,  because  here,  the  vessels  of  the  middle  ear  and  those 
of  the  drum-head  inosculate. 

For  this  fact  we  are  indebted  to  Wild  and  Von  Troltsch.  The 


A.ttm ore’s  Paper. 


►  o 

00 


application  of  from  one  to  six  leeches  will  usually  suffice  lor  this 
purpost*:  pressure  being  removed,  and  hence  one  form  of  irrita¬ 
tion  being  gotten  rid  of.  the  disease  may  be  safely  guided  to  reso¬ 
lution,  which  is  its  natural  termination. 

I  do  not  believe  that  leeches  or  any  other  remedy  do  or  can 
cut  short  the  inflammatory  process.  I  would  therefore  use  the 
leeches,  to  remove  the  blood  that  is  there  in  too  great  quantity 
and  because  they  do  it  quicker  than  the  absorbents  can  accom¬ 
plish  it,  and  we  thereby  save  time,  as  well  give  relief  from  pain. 

But  leeches  are  troublesome,  and  sometimes  hard  to  get,  what 
are  we  to  do  then  ? 

Puncture  the  tragus,  apply  suitable  cups  and  encourage  the 
bleeding  by  the  application  of  warm  water.  I  have  been  led  to 
take  quite  a  different  view  of  the  treatment  of  acute  aural  catarrh, 
from  that  entertained,  by  the  authors,  to  whom  I  have  had  access, 
viz  : — Iioosa,  Yon  Troltsch  and  Toynbee.  We  know  that  the 
mucous  membrane,  lining  the  middle  ear,  is  extremely  delicate — 
and  that  it  consists  chiefly  of  epithelium  and  a  layer  of  consecu¬ 
tive  tissue  underneath  ;  the  thinness  of  which  tempted  Von 
Troltsch  to  state  that  the  mucous  membrane  could  not  be  sepa¬ 
rated  from  the  periostium,  hence  every  catarrh  of  this  part,  is  a 
periostitis  ;  but,  Kessel  has  proved  that,  “  the  connective  tissue  of 
the  mucous  membrane,  in  some  places,  forms  a  fibrous  frame¬ 
work,  which  separates,  from  the  periostium  and  passes  from  one 
projection  of  bone  to  another,  through  the  free  space  of  the 
cavity. 

One  such  bridge,  according  to  Roosa.  has  been  frequently  ob¬ 
served  to  pass  from  the  eminentia  pyramidalis,  to  the  processus 
cochleariformis,  while  many  are  seen  on  the  floor  of  the  tym¬ 
panum.  Hence  I  have  concluded,  that  in  this  morbid  process, 
we  encounter  an  inflammation,  analogous  to,  if  not  essentially  a 
cellulitis,  and  that  the  administration  of  remedies  calculated  to 
overcome  this  disease,  will  be  attended  with  the  best  results,  in 
acute  aural  catarrh. 

Foremost  among  these,  1  would  place  quinine.  I  look  upon 
quinine,  as  having  a  direct  controlling  effect  upon  the  migrations 
of  the  leucocytes,  and  since  Strieker  and  Conheim,  have  shown 
this  to  be  the  essence  of  the  inflammatory  process,  I  have  looked 
upon  quinine,  as  the  remedy,  par  excellence. 


54  Attmore’s  Paper. 

We  all  know  and  are  prepared  to  admit,  that  as  an  equalizer  of 
the  circulation  it  has  no  superior,  it  matters  not  here  how  it  does 
this,  if  the  fact  be  admitted,  and  I  have  proved  it  repeatedly  to 
my  own  satisfaction.  Then  this  is  another  indication  for  its  ad- 
istration. 

As  a  reducer  of  febrile  action,  and  heat,  it  will  also  be  found 
very  valuable  ;  for  have  we  not  here  all  the  symptoms  of  pyrexia? 
with  its  quick  pulse  and  high  temperature. 

The  bromide  of  potassium,  either  in  conjunction  with  the 
quinine  or  separately,  will  be  found  a  valuable  therapeutic  agent, 
it  being  a  direct  sedative  to  the  nerves,  supplying  all  mucous 
surfaces  and  diminishing  the  secreting  functions  of  all  mucous 
membranes,  besides  being  also  a  sedative  to  the  circulation. 

For  the  relief  of  pain,  morphine,  combined  or  not  with  some 
preparation  of  gelsemium,  will  be  found  sufficient.  Chloral, 
hydrat,  and  crotan  chloral,  will  here  also  serve  our  purpose  ad¬ 
mirably,  particularly  the  crotan  chloral. 

As  local  remedies,  the  use  of  hot  water  has  superceded  all 
others,  it  being  allowed  to  run  into  the  ear.  in  a  continuous 
stream,  by  means  of  an  aural  douche,  an  instrument  similar  to 
the  nasal  douche  of  Weber. 

The  ordinary  syringe,  is  of  no  use  whatever  in  this  form  of  the 
disease,  it  being  better  to  pour  the  water  into  the  ear,  from  a 
suitable  contrivance;  a  small  pitcher  answering  very  well,  and 
to  repeat  it  every  few  minutes. 

Paracentisis  of  the  drum  membrane,  has  been  recommended, 
as  an  efficient  means,  for  the  relief  of  pain  and  to  prevent  loss  of 
tissue,  when  the  membraue  is  very  much  pressed  upon,  from 
within.  In  regard  to  this  operation  I  copy  from  Koosa — 
Schwartze,  of  Halle,  taught  us  the  value  of  this  means  of  treat¬ 
ment  in  acute  cases,  and  I  have  found  it  of  great  value. 

I  would  even  pass  a  cateract  needle  through  the  posterior  por¬ 
tion  of  the  membrane  in  any  case,  whether  bulging  were  seen  or 
not,  where  the  use  of  leeches  did  not  markedly  diminish  the 
severe  pain  within  a  few  hours.” 

The  operation  should  be  performed,  while  the  head  of  the 
patient  is  well  supported,  and  a  good  light  thrown  upon  the 
drum,  by  the  otoscope  attached  to  a  forehead  band. 

An  ordinary  cateract  needle  will  answer  very  well  for  the 


Attmore’s  Paper 


oo 


instrument  and  it  should  enter  in  the  posterior  inferior  portion 
of  the  membrane,  or  in  Shrapnel’s  membrane,  the  greatest  amount 
of  bulging  being  generally  found,  at  these  points. 

1  he  pain,  is  so  slight  that  the  surgeon  need  not  think  of  it. — 
If  we  find,  on  examination,  that  the  mastoid  region,  is  hot,  red, 
tender  and  swolen,  we  should  make  an  incision  down  to  the 
bone;  but  it  is  onlv  rarelv  that  this  is  the  case  in  acute  catarrh* 
I  bis  is  more  apt  to  be  found  in  sub-acute  or  chronic  suppuration. 

The  condition  of  the  pharynx  should  be  investigated  and  if 
found  inflamed,  should  receive  proper  attention.  One  of  the  best 
applications,  that  I  have  found  for  it,  being  a  turpentine  water, 
prepared  like  the  officinal  waters,  of  the  IT.  S.  P.  of  the  strength 
of  from  drams  2  to  drams  4  of  the  oil  to  the  pint  of  water,  and 
used  as  a  gargle. 


The  eustachian  catheter  and  Politzer’s  method  should  be  resorted 
to,  as  soon  as  the  acute  symptoms  subside,  thus  keeping  the  eusta¬ 
chian  tubes  pervious  and  blowing  the  mucus  that  may  have 
accumulated,  out  of  the  cavity. 

This  if  done  gently,  will  be  found  painless  and  beneficial.  The 
hearing,  should  be  tested,  with  the  watch  and  tuning  fork,  in 
order  to  see,  if  any  impairment  of  function,  has  taken  place;  for 
in  half  treated  acute  catarrhs,  is  laid  the  foundation  of  chronic 
non-suppuration  of  the  middle  ear.  These  loculi  means,  conjoined 
with  the  general  treatment  already  pointed  out,  will  T  am  sure, 
arrest  almost  all  cases  of  the  disease,  and  should  suppuration 
occur,  usually  it  will  be  found  tractable,  and  the  ear.  may  even 
then  be  restored  to  usefulness.  The  patient,  should  of  course* 
be  kept  in  a  warm  closed  room,  during  the  stage  of  pain  and  fever’ 
the  diet  should  be  nourishing  and  every  thing  should  be  done 
that  can  add  to  his  comfort.  The  practitioner,  who  while  treat- 
ins:  one  of  the  Zymotic  diseases,  should  find  this  inflammation 
breaking  out,  must  let  no  circumstance  connected  with  the 
former,  prevent  his  treating  the  local  disease  properly. 

Better  would  it  be  for  a  child  to  die  of  the  fever,  than  to  re¬ 
cover  from  one  of  these  maladies,  only  to  fall  a  victim  to  the 
effects  of  a  chronic  ear  disease. 

In  conclusion,  to  the  wish  of  the  illustrious  Professor  of  the 
New  York  University,  that  the  neglect  of  the  treatment  of  ear 
disease,  will  not  prevail  in  the  next  generation,  to  the  extent  it 
does  in  ours,  let  me  add  a  hearty,  amen ! 


56 


Individ u a  l  Ph  y s io log y 


(Appendix  D. ) 

Individual  Physiology,  or  the  Science  of  Individuality 


By  F.  Duffy,  M.  D.,  Newbern,  N.  C. 


Mr.  President  and  Gentlemen  : 

An  important  subject  for  scientific  investigation,  and  one,  the 
consideration  of  which,  is  indispensable  to  the  Physician,  is  that 
of  individual  Physiology. 

I  mean  by  this  term,  the  phenomena  of  life  manifested  by  each 
individual,  and  which  vary  in  degree  of  difference,  from  the  most 
striking  peculiarities  to  shades  of  difference  scarcely  discernable ; 
or  to  manifestations  which  are  common  to  most  or  to  all  persons: 
or  in  other  words,  some  of  these  phenomena  are  common  to  all 
persons,  the  majority  to  most  persons,  some  to  only  a  few,  and 
probably  some  are  manifested  in  only  one  individual;  while  each 
individual  has  a  combination  which  is  peculiar  to  himself.  I 
prefer  the  term  individual  physiology  to  that  of  idiosyncrasy 
which  as  defined  by  Dunlison,  is  “  a  peculiarity  of  constitution 
by  which  one  person  is  affected  by  an  agent  which  in  numerous 
others  would  produce  no  effect,”  and  Hammond  gives  a  definition 
about  the  same.  This  term  might  with  equal  propriety  be  used, 
but  as  far  as  my  observation  goes,  it  is  generally  applied  to  those 
striking  peculiarities  of  constitution  which  are  the  exception  ; 
while  individual  physiology,  in  the  sense  which  I  mean  it  to  ap¬ 
ply,  is  the  invariable  rule.  Hammond  says  idiosyncrasy  “  is  some¬ 
thing  inherent  in  the  organization  of  the  individual,  of  which 
we  only  see  the  manifestation  when  the  proper  cause  is  set  in 
action  ;  ’  and  further,  “  that  were  we  to  search  for  the  cause  with 
all  the  appliances  which  modern  science  could  bring  to  our  aid. 
we  should  be  entirely  unsuccessful.”  To  this  conclusion  I  think 
we  ought  to  be  very  slow  in  assenting,  as  many  difficulties  have 
been  surmounted  and  mysteries  solved  by  prolonged  and  patient 
investigations;  and  it  is  only  fair  to  presume  that  in  the  advance 
of  the  collateral  branches  of  science,  light  will  be  shed  on  this 
subject,  and  the  science  of  individuality  developed  to  that  degree 
in  which  truths  can  be  demonstrated  which  now  can  only  be 
dimly  foreshadowed  by  the  process  of  reasoning.  The  first  step 
in  the  development  of  this  knowledge  will  be  to  discard  the  idea 


Individual  Physiology 


57 


tlmt  peculiarities  belong  only  to  the  few,  and  regard  each  man  as 
being  more  or  less  unlike  his  fellows.  Of  the  thousand  millions 
of  inhabitants  of  this  earth,  we  have  no  proof  that  any  two  are  so 
nearly  alike  in  feature  and  physical  contour,  as  not  to  be  distin¬ 
guishable,  the  one  from  the  other,  on  accurate  comparison.  This 
is  doubtless  because,  that  in  the  examination  of  the  exterior,  we 
can  bring  so  many  of  our  senses  to  bear,  and  a  difference,  which 
would  not  be  detected  by  one  sense,  will  be  readily  observed  by 
another. 

Now  let  us  suppose  that  we  were  deprived  of  the  sense  of  sight 
— that  no  human  being  had  ever  seen,  while  possessing  all  of  our 
other  senses,  even  in  an  exalted  degree;  is  it  not  reasonable  to 
suppose  that  we  would  regard  a  large  number  of  mankind,  if  not 
the  majority,  as  being  identical  in  appearance. 

Measurement,  nor  the  sense  of  touch,  nor  that  by  which  we 
appreciate  weights,  nor  any  other  sense,  taken  separately  or  con¬ 
jointly,  would  be  sufficient  to  detect  those  differences,  at  once 
perceptible  to  the  sense  of  sight.  The  sense  of  touch  has  its 
peculiar  domain  ;  conveying  impressions  which  a  combination  of 
all  our  other  senses  could  not  convey. 

It  is  a  well  known  fact  that  an  adult  suddenly  endowed  with 
sight,  having  been  blind  from  infancy,  cannot,  with  the  sense  of 
sight,  perceive  rotundity;  but  at  first  requires  the  aid  of  the  touch 
to  enable  him  to  appreciate  more  than  a  mere  superficies,  until 
the  sense  of  sight  is  educated  by  the  sense  of  touch ;  notwith¬ 
standing,  he  may  have  felt  that  object  and  perceived  its  round  - 
ness  while  in  a  state  of  blindness.  If  these  special  states  or  con¬ 
ditions  require  special  senses  for  their  perception,  are  we  not 
warranted  in  the  conclusion  that  inanimate  objects  possess  physi¬ 
cal  characteristics  which  we  are  not  endowed  with  faculties  to 
perceive. 

Much  more  are  we  in  a  state  of  ignorance  in  regard  to  the 
complex  organization  of  man,  “fearfully  and  wonderfully  made” 
— physically,  morally  and  mentally. 

But  while  we  cannot  reasonably  hope  ever  to  fathom  all  the 
laws  of  his  being,  or  even  to  predict  with  certainty  the  quality 
and  quantity  of  effects  which  will  follow  the  administration  of  a 
certain  quantity  of  a  given  agent  in  a  given  case,  still  I  think  we 
may  hope  to  arrive  at  a  much  higher  degree  of  probability  in 


58 


Individual  Physiology. 


every  case.  If  we  accept  the  idea  of  the  distinct  individuality  of 
each  one  of  our  race,  as  regards  one  phenomenon  or  more,  (what¬ 
ever  may  he  the  average  degree  of  peculiarity,)  the  difficulties 
encountered,  in  the  investigation  of  that  case,  may  be  multiplied 
by  the  number  of  inhabitants  of  the  earth  to  get  the  dimensions 
of  one  field  of  investigation.*  Not  that  it  would  be  profitable  or 
possible,  for  one  man  to  do  more  than  acquaint  himself  with  a 
knowledge  of  those  vital  phenomena  that  occur  in  all  or  in  most 
individuals  of  our  race,  which  are  of  most  general  applica¬ 
tion ;  and  in  his  own  sphere,  to  study  individuality :  regarding 
each  person  as  the  possessor  of  peculiarities,  discovered  or  undis¬ 
covered. 

At  the  recent  meeting  of  the  British  Medical  Association,  at 
Norwich,  Dr.  Reynolds  is  reported  to  have  said  in  his  address? 
that  we  are  no  nearer  than  our  forefathers  to  an  understanding 
of  the  history  of  life,  and  that  we  are  never  likely  to  get  much 
nearer  to  such  an  understanding.”  He  advocated  “  those  specific 
differences  in  man  termed  idiosyncrasies,”  and  the  insufficiency 
of  statistics  in  enabling  us  to  deal  with  individual  cases. 

If  we  examine  the  causes  of  such  discrepancies  as  exist  in  the 
statements  of  physicians,  in  regard  to  the  action  of  medicines  in 
various  conditions,  we  will  have  to  ascribe  much  of  it  to  pecu¬ 
liarities  of  patients  ;  though  this  is  bv  no  means  the  only  cause. 
It  is  hardly  necessary  to  allude  to  the  various  effects  of  sorri  e 
drugs,  except  to  prepare  us  to  admit  differences  less  demonstrable 
in  others.  The  amount  of  opium  which  would  soothe  one,  would 
craze  another.  A  dose  of  oil  of  turpentine  that  would  produce 
no  unpleasant  effects  on  one  person,  would  be  attended  with  the 
most  distressing  effects  in  another;  and  these  two  not  uniform. 
Even  the  external  use  of  this  remedy  produces  widely  different 
effects,  both  general  and  local.  Some  skins,  which  to  all  appear¬ 
ances  are  more  delicate  than  others,  are  irritated  less  by  an  ap¬ 
plication  of  this  remedy.  In  fact  I  believe  that  all  medicines,  the 
effects  of  which  are  easiest  to  demonstrate,  show  as  a  rule  differ¬ 
ent  effects  on  different  individuals,  at  least  in  degree.  Herbert 


Spencer  says  in  his  “  Genesis  of  Science  ”  that  “  our  first  achieve¬ 
ment  is  to  foretell  the  kind  of  phenomena  which  will  occur 
under  specific  conditions:  our  last  achievement  is  to  foretell  not 
only  the  kind,  but  the  amount ;’  and  further  that  all  sciences  are 


Individual  Physiology. 


59 


qualitative  in  their  first  stages.  Now  let  us  suppose  we  take 
thiee  men  under  similar  conditions  and  find  the  minimum  dose 
of  Epsom  salts  which  will  produce  catharsis  in  each  case:  it  will 
most  likely  vary,  and  that  widely,  if,  in  the  selection  of  our  cases 
we  are  not  careful  to  note  every  discoverable  co-existence  which 
could  aid  or  retard  the  action  of  the  agent.  We  may  say  as 
much  ot  any  cathartic;  and  of  emetics  in  the  production  of 
emesis.  If  we  say  that  there  is  no  practical  disadvantage  in  a 
larger  quantity  of  these  medicines  than  is  required  to  produce 
their  physiological  effect,  in  as  much  as  the  redundancy  is  ejected 
from  the  system,  ('which  is  not  generally  the  case,)  we  cannot 
apply  this  remark  to  such  medicines  as  are  absorbed  into  the 
blood  and  going  their  rounds  in  the  circulation,  make  their  im¬ 
press  on  the  vital  organs.  If  the  effects  of  a  remedy  is  in  propor¬ 
tion  to  the  amount  administered,  a  definite  quantity  must  be 
required  to  produce  the  best  results  in  a  given  case  ;  and  while  a 
deviation  from  that  quantity  may  be  attended  with  good  results, 
still  we  have  not  attained  the  highest  success.  This  seems  to 
admonish  us  that,  after  acquainting  ourselves  with  the  most  in¬ 
variable  effects  of  a  remedy,  we  should  administer  it  tentatively — 
regarding  effects  rather  than  the  amount  used.  A  remedy  most 
frequently  used  is  Quinine.  We  might  suppose  that  there  could 
be  no  question  as  to  its  effects  and  the  indications  for  its  use* 
Still  outside  of  the  admission  that  it  is  in  some  way  antidotal  to 
Malaria  or  remedial  to  its  effects,  there  is  considerable  difference 
of  opinion,  and  probably  as  fast  as  one  disputed  point  is  settled 
or  abandoned  another  will  present  itself.  It  may  not  matter  with 
the  practical  physician  whether  in  the  accomplishment  of  its 
mission,  it  restores  a  normal  ingredient  (Chinoidine)  to  the  ani¬ 
mal  tissues,  or  eliminates  or  destroys  vegetable  spores,  or  main¬ 
tains  the  equilibrium  between  the  sympathetic  and  c^rebro-spinal 
nervous  systems,  or  in  what  manner  it  acts  ;  so  that  it  is  effectual* 
But  he  will  need  to  consider  the  susceptibility  or  resistance  of  his 
patient  to  its  influence  :  and  to  get  its  characteristic  effects,  and 
accomplish  his  object,  will  need  to  administer  to  one  much  more 
than  to  another,  even  in  hypodermic  injection,  in  which  case 

non-absorption  cannot  be  plead. 

Two  young  men,  whose  places  of  business  joined,  were  recently 
taking  Quinine  under  my  direction  to  ward  off  malarial  fever. 


GO 


Individual  Physiology 


In  the  one  case,  where  the  usual  prodromes  showed  that  an  at¬ 
tack  was  imminent,  a  dose  of  six  or  eight  grains  was  sufficient  to 
prevent  any  further  manifestations,  and  needed  not  to  be  repeated 
for  several  weeks  or  longer;  while  in  the  other,  six  or  eight  grains 
daily  and  an  additional  ten  grain  dose  on  Saturday,  the  day  of 
the  chill,  produced  but  little  effect  for  two  or  three  weeks.  I 
might  give  many  illustrative  examples,  but  no  doubt  it  will  be 
sufficient  to  ask  you  to  compare  results  in  your  own  practice  for 
any  more  that  you  may  need.  Much  has  been  said  of  the  oxytocic 
properties  of  Quinine;  the  principle  I  am  trying  to  advocate  may 
be  some  explanation  of  the  adverse  views  held  on  this  subject. 
For  my  own  part  I  am  satisfied  that,  by  the  use  of  Quinine,  I  have 
prevented  miscarriages  and  worse  consequences.  At  the  same 
time  I  remember  two  cases  in  which  premature  delivery  followed 
its  use,  and  the  arrest  of  fever.  One  of  these  cases  was  in  a  state 
of  malarial  cachexia  and  had  miscarried  in  former  pregnancies 
before  coming  under  my  advice. 

It  may  not  be  irrelevant  to  the  subject  to  say  that  I  have  been  led 
to  believe,  from  observation,  that  as  a  rule  when  there  is  any  dis¬ 
position  to  uterine  haemorrhage.  Quinine  aggravates  that  tendency, 
though  it  is  often  the  least  of  evils.  Also  I  will  say  in  this  con¬ 
nection,  that  I  have  been  accustomed  to  regard  quinine  as  harm¬ 
ful  in  cases  of  dysentery  as  far  as  the  intestinal  inflammation  per 
se  was  concerned.  This  opinion  I  believe  is  not  in  accordance 
with  the  more  general  and,  it  may  be,  more  correct  views  of 
others.  The  disease  however,  with  us  is  so  often  associated  with 
malaria,  that  there  can  be  no  question  as  to  the  frequent  necessity 
of  Quinine. 

In  the  case  of  an  infant,  less  than  a  year  old,  suffering  with 
entero-colitis  and  malarial  fever,  I  was  informed  by  the  mother 
and  also  by  the  father,  who  was  a  physician,  that  Quinine  aggra¬ 
vated  his  pains,  and  produced  bloody  discharges  from  the  bowels. 
Such  was  the  necessity  for  its  use,  that  I  insisted  on  giving  him 
a  dose — I  think  half  a  grain — the  administration  of  which  was 
attended  with  the  usual  screaming,  and  bloody  discharges  which 
had  been  accustomed  to  follow  its  use,  and  which  I  could  hardly 
think  was  only  coincidence.  Doctors  0.  Duffy,  Jr.,  and  Geo.  S. 
Attmore,  have  recently  informed  me  of  a  patient  who  is  invaria¬ 
bly  attacked  with  a  Papular  Rash  after  taking  Quinine.  It  has 


Individual  Physiology. 


61 


not  been  my  purpose  to  treat  of  the  action  of  Quinine  or  any  other 
agent,  except  as  a  ready  means  of  illustrating  individual  physiolo¬ 
gy-  I  might  allude  to  many  other  medicines  and  foods,  in  the 
range  of  my  own  experience  and  in  the  experience  of  others,  writ* 
ten  and  unwritten,  which  have  produced  effects  unusual  and  ex¬ 
traordinary  from  no  other  reason  apparently,  than  the  peculiarity 
of  the  recipient.  Even  while  I  write  a  negro  patient  comes  to 
report  an  unusual  degree  of  perversion  of  sight,  from  the  use  of 
an  ordinary  dose  of  the  alkaloid  Gelsemin.  The  unwelcome 
conclusion  forces  itself  upon  our  minds,  that  in  the  existing  state 
of  knowledge,  or  rather  lack  of  it,  the  best  directed  efforts  of  the 
most  scientific  physicians,  as  a  rule,  are  but  approaches  more  or 
less  near  to  perfection.  Nor  am  I  to  be  understood  as  depreciat¬ 
ing  his  attainments  or  usefulness.  He  lays  under  contribution 
every  science,  art  is  exhausted  in  bringing  to  his  aid  new  and 
wonderful  appliances,  to  assist  him  in  his  investigations.  Still 
not  certitude  but  only  “probability  is  the  guide”  of  his  useful 
life.  Instead  of  first  indicating  individual  peculiarities  by  the 
multiform  actions  of  medicines,  I  might  have  alluded  to  the 
anatomical  or  physical  peculiarities  of  man,  in  each  organ  or  sys¬ 
tem  of  organs,  to  the  manifestations  of  difference  in  the  exercise 
of  the  physiological  functions  of  similar  organs  in  different  per¬ 
sons,  intellectual  and  moral  peculiarities,  climatic  influences,  and 
other  influential  circumstances,  in  all  of  wnich  it  would  be  next 
to  impossible  to  find  any  two  persons  in  exact  correspondence  ; 
and  then  have  asked,  how  could  the  application  of  any  agent  be 
attended  with  uniform  results  under  such  unlike  conditions? 
And  would  not  more  accurate  observation  convince  us  that  our 
results  (in  practice)  are  less  uniform  than  we  now  suppose? 

But  almost  unconsciously  I  find  myself  beginning,  as  it  were, 
at  the  top  and  proceeding  toward  the  foundation;  which  seems 
to  have  been  the  manner  of  evolution  of  the  medical  science  from 
the  beginning.  Vesalins,  the  first  dissector,  published  his  “  seven 
books  on  the  structure  of  the  human  body”  about  two  thousand 
years  after  the  illustrious  Father  of  Medicine,  had  written  his  de¬ 
scription  of  diseases  and  indicated  his  treatment.  Phenomena 
are  usually  observed,  before  their  laws  are  understood.  We  may 
reason  from  cause  to  effect,  but  not  less  frequently  from  effect  to 
cause _ {X  relation  which  must  always  be  understood  to  exist, 


62 


Individual  Physiology. 


though  it  cannot  always  be  demonstrated. 

This  brings  us  to  a  consideration  of  such  circumstances  as 
should  determine  the  application  of  therapeutics  in  individual 
cases.  For,  notwithstanding  the  materia  medica  is  a  com  pari  - 
tively  small  part  of  the  range  of  medical  study,  it  is  a  culmina¬ 
ting  point.  The  cure  and  prevention  of  disease  is  the  object  of  a 
patient  in  seeking  the  physician.  The  most  profound  knowledge 
of  the  medical  and  collateral  sciences,  the  most  intimate  acquaint¬ 
ance  with  their  theoretical  and  practical  details,  will  be  nugatory, 
to  the  patient,  if  we  fail  to  find  a  remedy  for  his  malady. 

The  points  to  note  in  investigating  a  case  are  clearly  taught  in 
medical  works  and  need  not  be  enumerated.  But  it  seems  to  me, 
that  as  far  as  therapeutic  indications  are  concerned,  this  is  some¬ 
what  barren  of  results;  at  least  there  are  not  as  many  shades  of 
difference  in  prescriptions  as  there  are  in  patients.  These  ought 
to  be  in  proportion  to  each  other.  But  the  reason  that  they  are 
not  is  obvious:  the  influences  of  these  various  circumstances  are 
not  definitely  ascertained.  True  we  have  certain  general  rules 
as  to  selection  of  remedhs,  and  proportioning  of  doses,  to  age,  sex? 
constitution,  &c.,  all  of  which  is  good  as  far  as  it  goes;  but  for 
example,  let  me  ask.  is  there  as  much  difference  in  the  treatment 
of  the  white  and  black  races  as  there  is  in  their  organization  ? 

In  Tanner’s  clinical  medicine,  the  44 general  mode  of  taking  a 
case,”  is  perhaps  as  comprehensive  and  exhaustive  as  can  be,  until 
other  facts  are  discovered  which  are  capable  of  serving  as  indica¬ 
tors  to  our  judgement.  We  are  taught  to  take  nothing  for 
granted,  to  carefully  examine  for  ourselves,  and  to  intero&ate 
every  circumstance  that  could,  in  any  way,  throw  light  upon  the 
case.  If  this  were  done  and  the  minutiae  indicated,  were  invaria¬ 
bly  attended  to,  even  at  our  present  stage  of  advancement,  physi¬ 
cians,  in  the  aggregate,  would  be  a  much  more  useful  class  of 
society,  than  they  are  at  present.  But  additional  knowledge 
would  accrue  from  the  incessant  application  of  many  minds  to 
the  labor  of  investigating  and  recording  those  exact  conditions 
which  exist  in  each  case,  and  upon  which,  the  variety  in  the 
effects  of  medicines  must  depend ;  assuming  that  they  are  not 
mere  random  events,  independent  of  any  law,  and  also  that  they 
are  not  miracles.  In  this  investigation  it  would  be  required  to 
consul ei  the  specific  differences  in  individuals,  under  the  same 


Individual  Physiology. 


G3 


externa]  conditions,  and  also  those  due  to  external  influences. — 
t  or  the  elucidation  of  the  former,  Anatomy  and  Physiology,  and 
uluit  of  truth  there  is  in  Phrenology  and  Physiognomy,  should  be 
observed.  Every  characteristic  which  marks  the  individual  should 
be  noted  and  its  influence  if  possible  ascertained.  And  for  the 
latter,  the  elements  which  in  the  aggregate  constitute  climate? 
educational  influences,  etc.,  should  be  be  taken  into  account. 

Herbert  Spencer  says  “ that  certainty  which  direct  perception 
gives  us  respecting  co-existences  and  sequences  of  the  simplest 
and  most  accessible  kind,  science  gives  us  respectiong  co-exist¬ 
ences  and  sequences  complex  in  their  dependencies  or  inaccessible 
to  immediate  observation.”  It  is  to  be  hoped  that  the  applica¬ 
tion  of  science  to  this  complex  subject,  will  not  be  barren  of 
results. 

I  am  tempted,  already,  to  venture  some  opinions  concerning 
the  action  of  certain  agents  on  persons  of  certain  organization,  (as 
a  commencement  of  the  journey  toward  the  individual),  also  on 
peculiarities  of  several  nationalities;  but  the  occurences  to  which 
f  allude,  may  be  only  coincidences,  in  some  instances  at  least., 
which  a  more  entended  observation  may  prove  to  be  exceptional, 
or  accidental.  Probably  the  individual  experience  of  every  care¬ 
fully  observant  physician,  furnishes  him  with  numerous  signs  or 
indications,  which  constitute  the  “unwritten  word”  or  unworded 
thought  of  medicine — harder  to  describe  then  to  recognize. 

I  have  already  alluded  to  the  fact  that  special  conditions  require 
special  senses  for  their  perception,  and  to  the  probability  that  the 
human  organism  and  even  inanimate  objects,  possess  characteris" 
tics  which  we  are  not  endowed  with  faculties  to  perceive,  and  of 
which  we  must  necessarily  remain  ignorant;  but  with  the  facul¬ 
ties  we  possess,  by  accurate  observation,  a  few  generations  of  as 
might  generalize  many  exceptional  phenomena,  and  discover  their 
laws;  and  if  indeed  “  we  are  no  nearer  than  our  forefathers  to 
an  understanding  of  the  mystery  of  life,”  we  are  nearer  than  they? 
to  an  understanding  of  the  mysteries  of  the  living;  and  will 
likely  continue  to  get  still  nearer  and  nearer. 

In  making  these  remarks,  I  am  aware  that  I  have  referred  to 
much  that  is  generally  known,  and  perhaps  to  nothing,  that  has 
not  already  attracted  your  attention;  as  even  new-born  ideas  are 
rather  the  offsprings  of  periods  than  of  individuals.  Some 


64 


Semi- Annual  Address 


pioneer  in  this  field  may  have  already  extended  his  lines  far 
beyond  my  limits,  and  if  in  this  effort  I  have  to  some  extent  (in 
the  language  of  another)  launched  forth  in  the  great  sea  of specu" 
laton  and  indulged  in  “  vague  wanderings  over  unknown 
waters”  I  hope  I  have  been  able,  at  least,  to  show  the  “  floating 
leaves  and  flowers  of  approaching  land.” 

- >  <  ♦  > « - 

(Appendix  E. ) 

ADDRESS 

Delivered  before  the  Eastern  (N.  C. )  Medical  Association  at  its  first  Semi- 

Annual  Meeting,  held  at  Wilson,  N.  C. 

By  J.  F.  Miller,  M.  D.,  Goldsboro,  N.  C. 

Mr.  President  and,  Brethren  of  the  Medical  Association  of 
Eastern  (Ar.  C.)  Ladies  and  Gentlemen : 

In  discharging  the 

duty  imposed  upon  me  at  this  hour,  by  the  kind  partiality  of  my 
professional  brethren,  I  promise  to  be  brief,  and  shall  touch  only 
a  few  of  the  more  salient  points  of  the  subjects  considered  in  this 
rather  desultory  and  somewhat  disjoined  address. 

It  is  a  right  conceded  by  our  Republican  form  of  Government 
to  all  parties  and  organizations,  whether  ecclesiastical,  political 
or  scientific  in  their  character,  having  for  their  object  the  best 
interests  of  society,  to  meet  together  to  define  their  principles, 
promulgate  their  doctrines  and  otherwise  extend  their  usefulness. 
Latterly  these  organizations  have  greatly  multiplied  both  in 
members  and  character.  Those  who  foster  and  represent  the 
commercial  interests  of  the  country  have  their  grand  Commercial 
Conventions, — the  Mechanics  and  Typographical  Corps — these 
useful  classes  of  our  fellow-citizens — have  their  Trades  Union,  and 
still  more  latterly  our  Agricultural  population — most  aptly  styled 
the  bone  and  sinew  of  the  land — are  organizing  throughout  the 
wide  extent  of  our  country  into  Granges  or  Patrons  of  Husbandry. 

Our  business  is  not  with  any  of  these  to-night,  but  they  are 
mentioned  simply  to  show  that  the  members  of  the  Medical  Pro¬ 
fession  form  no  exception  to  the  rule  when  they  meet  in  Conven¬ 
tion.  We  have  met,  Mr  President  and  Brethren,  for  no  selfish 
aggrandizement  in  the  way  of  pecuniary  gain,  but  for  the  advance- 


Semi-Annual  Address. 


65 


men  o  the  best  interests  of  society,  by  promoting  the  harmony, 
j.  t  m  ing  the  honor,  and  elevating  the  character  of  the  members 
om  I  lofession.  Our  duty  here  is  not  to  establish  a  fee  bill — 

(  claie  wluit  each  member  of  this  Association  shall  charge  for 
■t  visit,  a  piescription  or  for  certain  surgical  operations,  nor  for 
the  ignoble  purpose  of  hindering  or  preventing  any  worthy  aspi- 
Dint  into  our  professional  circle.  But  our  hearts  and  arms  are 
open  wide  to  receive  every  worthy  member  of  the  healing  Art, 
and  to  the  young  men  of  the  country,  who  have  the  necessary 
qual ideations  and  who  desire  to  enter  our  ranks,  none  will  be 
found  more  willing  and  ready  to  give  a  word  of  encouragement 
and  sympathy  than  the  medical  gentlemen  composing  this  Asso¬ 
ciation.  Nor  is  the  organization  of  this  Association  in  any  sense 
antagonistic  to  the  interests  of  the  State  Medical  Society  of  the 
State  of  N.  C.  Some  of  its  leading  members  and  brightest  orna¬ 
ments — those  who  have  borne  the  heat  and  burden  of  the  day  and 
contributed  perhaps  as  much  as  any  others  to  the  rise,  progress 
and  usefulness  of  the  parent  Society — are  also  worthy  and  hon¬ 
ored  members  of  this  Association.  The  Medical  Society  of  the 

•/ 

State  extends  over  such  a  vast  area  of  country,  that  many  medical 
gentlemen  who  would  delight  in  attending  its  pleasant  annual 
meetings  are  prevented  by  the  great  distance  that  separates  them 
from  the  points  at  which  the  meetings  are  held.  But  our  Asso¬ 
ciation  is  auxiliary  to  the  parent  or  State  Medical  Society  and 
cannot  possibly  conflict  with  any  of  its  interests  and  objects,  but 
rather  aid  in  fostering  those  interests  and  advancing  the  most 
worthy  objects  contemplated  in  its  organization.  A  high  and 
pure  motive  principle,  we  believe,  conceived  the  idea  of  organizing 
the  Medical  Association  of  Eastern  N.  C.,  and  we  trust  a  like 
motive  has  brought  us,  under  the  Divine  Providence,  to  this  the 
first  meeting  after  our  organization — “  the  advancement  of  med¬ 
ical  knowledge,  the  elevation  of  professional  character  and  the 
promotion  of  all  measures  of  a  professional  nature  that  are  adapted 
to  the  relief  of  suffering  humanity.”  While  we,  as  a  profession, 
do  not  claim  exemption  from  those  weaknesses  common  to  frail 

humanity _ the  love  of  gold  and  silver,  of  lands  and  houses— of 

personal  and  professional  ambition— we  do  insist  that  the  teach- 
iugs  and  practice  of  the  Science  of  Medicine  look  far  above  and 
and  beyond  the  mere  pecuniary  advantage  that  will  likely  accrue 


6G 


S EM i- A  N N UAL  Ann r ess 


to  those  who  assume  its  almost  sacred  offices.  The  man  who  takes 
his  position  in  our  ranks  merely  for  “  the  loaves  and  fishes  ” — 
the  dollars  and  cents  that  can  he  made  out  of  the  profession — is 
at  best  a  mere  trafficker  in  human  life  and  human  suffering. 

But  the  consciousness  of  doing  good — to  be  the  happy  though 
humble  instrument  in  relieving  human  pain  and  anguish — to 
cause  the  human  heart  to  throb  with  a  new  joy,  the  smile  of  a 
new-born  hope  to  light  up  the  anxious  face  because  of  returning 
health  to  some  loved  one,  and  to  receive  the  blessing  of  some  poor 

creature  of  toil  and  poverty - perchance  some  widowed  heart 

unable  to  offer  pecuniary  reward  for  our  “  work  of  faith  and  labor 
of  love”  in  behalf  of  herself  and  family — these  are  oftimes  to  the 
noble  nature  higher  rewards,  more  blessed  and  soul -satisfying 
than  the  value  of  gold  and  silver.  What  nobler  object  of  an  earthly 
character  can  enlist  the  sympathies  and  stimulate  the  energies  of 
the  Philanthropist,  Patriot  and  Christian,  than  the  application  of 
Heaven’s  bounteous  provisions  in  healing  the  sick  and  mitigating 
the  sufferings  of  afflicted  humanity!  How  dignified  and  exalted 
the  office  of  him  who,  in  imitation  of  the  great  Physician,  g)es 
about  doing  good — exemplifying  the  beauty  and  excellency  of 
medical  learning!  How  sublime  and  heroic  the  self-sacrifices 
this  office  often  imposes  upon  the  true  Physician  as  he  goes  on 
his  errands  of  mercy  amid  the  “pestilence  that  walketh  in  dark¬ 
ness  and  the  destruction  that  wasteth  at  noon-day !” 

In  obedience  to  the  dictates  of  these  noble  impulses  of  the 
heart — to  this  unselfish  feeling  of  our  high  calling,  we  trust  we 
have  been  brought  together  on  this  interesting  occasion.  We 
have  come  together  from  our  several  fields  of  labor  to  compare 
notes  of  experience  that  we  have  gathered  in  the  treatment  of 
disease — to  speak  to  each  other  of  our  doubts  and  fears  as  we 
have  stood  by  the  bed  of  the  sick  and  the  dying — to  assist  in  re¬ 
moving  these  unpleasant  mental  conflicts,  the  one  from  the  other, 
and  to  cultivate  that  fraternal  spirit  that  should  bind  together 
the  hearts  of  all  those  who  feel  a  common  interest  in  the  advance¬ 
ment  of  professional  knowledge. 

An  appreciative  and  enlightened  public  sentiment  has  long 
since  recognized  ours  as  one  of  the  learned  professions,  and  ac¬ 
corded  to  each  worthy  member  an  honorable  position  in  society. 
The  names  of  our  illustrious  brethren  in  the  profession  are  asso- 


Semi- Anx ual  Address. 


(>  rV 

>7 


ci;ited  with  heroes,  statesmen  and  sages  in  History  and  in  Song, 
and  to  us  who  are  here  assembled  is  committed  the  rich  legacy  of 
thoil  laborious  thought  and  invaluable  contributions  to  scientific 
medicine.  Let  us  not  prove  recreant  to  the  high  and  important 
i 1  lists  committed  to  us;  but  with  the  aid  of  new  lights  afforded 
iet  us  take  broader  views  and  higher  conceptions  of  our  duties  to 
each  other  and  to  society,  and  go  forward  to  the  attainment  of  a 
sounder  phylosophy  in  the  practice  of  our  profession.  While 
much  has  been  done  by  our  professional  fathers  much  yet  remains 
to  be  done  in  perfecting  our  science.  As  yet  ours  is  not,  and 
possibly  may  never  be  one  of  the  exact  sciences  like  Mathematics 
or  even  Astronomy,  but  it  is  one  of  most  reasonable  probabilities. 
The  history  of  its  rise  and  progress  is  one  of  struggles  against 
ignorance,  prejudice  and  superstition.  In  its  history,  to  some 
extent  at  least,  the  truth  of  to-day  has  been  the  error  of  the  mor¬ 
row.  It  has  been  ironically  remarked  that  Broussais  invented 
inflammation  and  bleeding,  while  many  of  his  cotemporaries 
never  dreamed  of  the  one  nor  practiced  the  other — the  one  re¬ 
garding  inflammatory  action  as  an  exaltation  of  the  vital  forces 
while  the  other  regarded  it  a  depression  of  the  nervous  system. 
Varied  theories  and  diverse  practice  obtained  among  learned 
Doctors  at  the  same  times  and  at  different  periods  of  our  medical 
history.  Thus  we  have  had  stimulating  Doctors  and  debilitating 
Doctors,  and  even  in  our  own  day  there  are  not  a  few  who  affirm 
that  with  the  aid  of  Alcohol  and  a  full  diet  they  can  cure  all  curable 
diseases  that  “flesh  is  heir  to.”  From  the  earliest  records  to  the 
present  time  there  have  been  all  kinds  of  Gods  and  Goddesses  relied 
upon  and  applied  to  in  the  art  of  healing,  such  as  demons,  as¬ 
trologers,  conjurors  and  witches,  and  in  late  times  spiritual,  table¬ 
turning  Doctors,  and  many  other  sects.  The  virtues  and  efficacy 
of  some  of  the  leading  articles  of  the  Materia  Medica  that  come 
to  us  sanctioned  by  the  experience  of  ages  and  by  all  the  wise  and 
<>  reat  that  have  graced  the  annals  of  our  profession  have  been  de- 
nied  by  learned  men  in  the  profession.  So  that  there  have  been  at 
all  times  extremists  in  the  profession  who  have  sought  to  rule  the 
medical  world  and  have  succeeded  to  some  extent  in  impressing 
their  age  with  their  pet  theories  and  peculiar  notions.  It  is  a 
o-reat  misfortune  that  these  discrepancies  in  the  theory  and  prac¬ 
tice  of  medicine  should  ever  have  existed  ;  but  it  is  cause  for  con- 


68 


Semi-Annual  Address. 


gratulation  to  know  that  never  before  has  the  medical  world  been 
so  united  in  the  general  principles  of  treatment  of  disease  as 
now.  Truth  often  lies  embedded  in  the  rubbish  of  much  error, 
and  it  is  for  us  in  this  day  of  rapid  strides  in  the.  advancement  of 
all  the  arts  and  sciences  to  remove  the  rubbish  of  errors  and  dis¬ 
crepancies  that  clog  the  wheels  of  medical  progress.  But  our 
system  of  truth  as  taught  by  the  Faculties  and  practiced  by  the 
varied  members  of  the  profession  does  not  stand  alone  in  the 
clashings  of  contrariety  of  opinions  and  conflicting  dogmas.  In 
all  systems  of  truth  where  orthodoxy  allows  latitudinarian  in 
opinion  and  practice,  the  human  mind  is  so  constituted  that  there 
will  necessarily  be  a  contrariety  of  views  and  sentiment.  Even 
the  Christian  Religion  is  not  free  from  theological  conflicts 
among  its  votaries,  though  all  learn  from  the  same  great  book 
and  sit  at  the  feet  of  the  same  great  Teacher.  While  these  con¬ 
flicts  are  to  be  deplored,  none  the  less  in  Religion  than  in  Medi¬ 
cine,  we  humbly  conceive  they  are  inseparably  associated  with 
our  imperfect  knowledge  of  Nature’s  laws  and  Nature’s  God.  Our 
profession  forges  no  cast-iron  jackets  to  invest  her  disciples;  nor 
does  it  rest  upon  the  dictum  of  any  theorist  or  set  of  theorists  ; 
but  it  is  founded  upon  experience  and  observation.  The  specu¬ 
lative  opinions  of  the  few  cannot  overthrow  the  speculative  opin¬ 
ions  of  the  many  in  matters  where  all  are  equally  qualified  to 
judge,  having  the  same  or  equal  opportunities  to  observe.  In  a 
matter  purely  experimental  the  opinion  of  one  man  cannot  out¬ 
weigh  the  experience  and  opinion  of  a  thousand.  In  this  con¬ 
nection  I  may  safely  assert  that  Medicine  is  the  most  difficult 
and  intricate  of  all  the  Sciences,  because  its  materials  though 
consisting  of  facts  are  related  to  and  blended  with  vitality,  the 
nature  of  which  has  ever  transcended  experimental  research. 
With  all  our  boasted  knowledge  and  progress  we  are  ignorant  of  the 
changes  that  take  place— those  in  ward,  occult,  disturbing  influences 
— in  any  disease.  Life  itself,  while  a  grand  thing,  is  also  a  grand 
mystery.  We  understand  many  of  the  manifestations  of  life,  but 
the  most  advanced  scientist  has  never  been  able  to  tell  us  what 
is  the  vital  principle.  Each  one  present  carries  about  and  within 
us  a  grand  mystery — the  circulation  of  the  blood  in  the  constant 
maintainance  of  our  lives.  Unlike  any  other  muscular  tissue  of 
the  body,  it  ever  toils  but  never  grows  weary.  From  “  rosy  morn 


Semi-Annual  Address. 


GO 


till  dewy  eve/  from  year  to  year,  whether  we  sleep  or  labor,  it 
beats  all  the  while,  keeping  life’s  current  in  motion,  and  yet  the 
foice  that  controls  the  heart’s  action  is  as  independent  of  our 
wills  as  the  force  that  moves  the  sun  in  the  heavens.  In  the 
clouds  above  us  that  defy,  in  their  graceful  equilibrium,  the  laws 
of  gravitation — in  the  leaves  of  the  forest  that  are  moved  by  the 
gentlest  zephyr — in  the  blades  of  grass  that  we  unconsciously 
trample  under  our  feet,  we  may  find  much  that  we  cannot  under¬ 
stand.  So  that  we  are  compelled  to  acknowledge  that  life  is  a 
mystery,  even  in  its  lowest  forms,  as  well  as  in  its  higher  and 
grander  manifestations  as  exemplified  in  humanity.  It  is  the 
grandest  thing  given  to  the  world,  for  it  invests  man  in  his  com¬ 
plex  nature  with  a  dignity  that  makes  him  but  “  a  little  lower 
than  the  angels,”  and  an  object  of  interest  to  all  created  intelli¬ 
gences.  And  how  mysterious  is  the  blending  of  this  complexity 
of  man’s  nature — this  union  of  mind,  soul  and  body — the  mate¬ 
rial  and  immaterial  parts  of  man  !  Who  can  tell  how  that  which 
thinks,  feels  and  reasons  can  be  imprisoned  in  these  human 
bodies,  and  how  mind  can  be  so  associated  with  matter  as  that 
the  one  obeys  the  mandates  ol  the  other!  Where  does  the  soul 
abide — in  what  part  of  these  material  bodies  does  it  make  its  di¬ 
vine  abode?  These  subjects  are  uncomprehended  by  and  incom¬ 
prehensible  alike  to  the  student  of  physics,  metaphysics  and  to  the 
student  of  medicine.  But  because  we  cannot  understand  the 
mysterious  union  of  the  soul  and  body  and  that  other  the  most 
wonderful,  perhaps  of  all  truths  ever  taught  to  man — the  eternal 
trinity — must  we  therefore  despise  metaphysical  theology  and 
ignore  the  plainer  teachings  of  man’s  duty  to  man  and  to  his  God  ? 
Assuredly  not.  Our  science,  like  the  Christian  Religion,  is  the 
child  of  an  inexorable  necessity ;  and  comparing  human  science 
with  things  divine,  like  it,  mankind  is  the  worthy  object  of  its  grand 
benevolence  and  sublime  sacrifices.  In  the  early  morn  of  exist¬ 
ence,  ere  the  trail  of  the  serpent  had  despoiled  his  primeval  purity, 
man  stood  forth  perfect  in  his  moral,  intellectual  and  physical 
conformation— the  crowning  glory  of  Heaven’s  creative  power- 
Why  he  fell  from  his  high  and  holy  estate,  and  of  the  means  used 
for  his  spiritual  restoration,  we  leave  for  divines  and  theologians 
to  discuss.  But  to  relieve  his  physical  wants  and  administer  to 
his  physical  necessities  arising  from  his  fall,  is  the  province  of 


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Semi-Annual  Address 


the  science  of  medicine.  As  the  seed  of  the  woman  which  should 
bruise  the  serpent’s  head  was  the  promised  panacea  of  man’s  spir¬ 
itual  ills,  consequent  upon  his  partaking  “  the  fruit  of  the  for¬ 
bidden  tree  whose  mortal  taste  brought  death  into  the  world  and 
all  our  woe,”  so  do  we  believe  that  the  same  loving  and  provident 
Hand  has  placed  within  our  reach  remedies  commensurate  with 
our  physical  wants  and  necessities.  From  that  day  until  now 
the  energy  and  ingenuity  of  man  has  been  taxed  to  discover  these 
remedies  and  to  learn  their  adaptation  to  the  varied  ills  that 
afflict  humanity.  From  that  day  until  now  our  science  has  been 
progressing  pari  passu  with  other  sciences.  Xo  martial  music 
nor  imposing  pageantry  has  announced  to  the  world  the  splendor 
of  her  triumphs;  but  as  silent  as  the  dews  of  Heaven  has  been 
her  onward  march.  If  Fulton  gave  to  the  world  the  application 
of  steam,  the  genius  of  the  immortal  Jenner  has  disarmed  of  its 
terrors  the  most  loathsome  disease  that  afflicts  humanity.  If 
telegraphy  has  annihilated  space  and  bound  together  with  electric 
cords  the  most  distant  nations,  the  anaesthetic  effect  of  Chloroform 
has  rendered  painless  the  most  heroic  operations  known  to  surgery. 
New  weapons  of  warfare  against  pain  and  disease  are  constantly 
being  wrought  out  in  the  laboratories  of  the  scientific  Chemist. 
Ours  indeed  is  pre-eminently  a  progressive  science.  New  truths  are 
constantly  being  elucidated  and  inculcated  and  false  premises 
and  deductions  exposed;  and  though,  as  before  declared,  ours  be 
not  of  the  exact  sciences,  and  in  consequence  of  facts  already  in¬ 
timated,  there  be  much  concerning  life  and  disease  that  we  can¬ 
not  understand,  our  profession  can  be  and  is  of  vast  importance 
to  mankind.  The  Physician  has  almost  a  superhuman  mission 
to  fulfill.  The  goal  of  his  ambition  stands  at  the  ultima  thule  of 
human  capacity.  He  would  gladly  know  all  the  secrets  of  organi¬ 
zation,  all  the  occult  mysteries  of  therapeutics,  physiology  and 
pathology;  but  such  perfection  of  human  knowledge  as  is  em¬ 
braced  in  a  thorough  understanding  of  the  nature  of  life,  of  mind 
and  even  of  matter  is  perhaps  beyond  the  reach  of  finite  capacity. 
But  most  fortunately  this  exactness  of  knowledge  is  not  necessary 
to  the  successful  practice  of  medicine.  We  may  aspire  to  this 
perfection — our  ambition  may  pant  for  its  dazzling  and  captivat¬ 
ing  heights,  and  though  we  may  never  reach  them,  yet  we  may 
continually  approach  unto  them.  The  successful  warrior,  Alex- 


Semi-Annual  Address 


71 


midei  like,  may  subdue  all  nations,  and  bis  insatiable  ambition 
may  weep  because  there  is  not  more  of  human  blood  upon  which 
to  gloat  its  rapacious  appetite;  but  the  ambitious  devotee  of 
medical  science  will  find  through  all  time  to  come  unconquered 
pio\ inces  that  lie  stretched  out  before  his  admiring  and  en¬ 
raptured  gaze — hidden  spots  in  the  fields  of  thought  that  will 
e\er  remain  unexplored — deep  problems  of  life  and  death  un¬ 
sounded  by  any  line  of  thought  cast  from  human  intellect.  But 
it  is  ominous  of  good — it  is  a  hopeful  sign  of  real  progress  in 
knowledge  when  we  have  discovered  our  errors  and  our  ignorance. 
The  night  of  prejudice,  superstition  and  error  that  for  so  long  a 
time  has  cast  her  sable  mantle  and  blighting  influence  over  our 
humane  and  benevolent  profession  is  well  nigh  spent;  and  al¬ 
ready  the  sun  of  Truth  is  lighting  up  the  Orient  with  the  efful¬ 
gence  of  his  rising  splendors.  In  this  rosy  morn — which  we  may 
most  reasonably  and  fondly  hope  will  be  but  the  prelude  to  a 
brighter  day  that  is  dawning  upon  the  medical  world — let  each 
of  us  come  manfully  to  the  task  of  removing  the  debris  of  de¬ 
molished  theories  and  systems — build  upon  the  ruins  thereof  a 
grand  and  noble  temple — adorn  it  with  the  pure  gold  we  have 
gathered  from  the  dross  of  centuries,  and  dedicate  it  to  a  more 
enlightened,  and  more  scientific  and  a  more  rational  system  of 
medicine  than  that  known  to  and  practiced  by  our  fathers. 


Errata. — On  page  9,  in  second  line  from  top,  for  “  preverbial  ”  read  “  pro- 
perbial.”  Same  page,  in  seventh  line  from  bottom,  for  “dispised”  read  “de¬ 
spised.”  On  page  10,  in  twentieth  line  from  top,  for  “dispised”  read  “de¬ 
spised.”  On  page  11,  in  seventh  line  from  top,  for  “crimnal  ”  read  “crimi¬ 
nal.”  Same  page’  seventeenth  line  from  top,  for  “organice”  read  “organic.” 
On  page  13.  in  eighth  line  from  top,  for  “  conciencious  ”  read  “con¬ 
scientious.”  On  page  16,  in  fifteenth  line  from  bottom,  for  “  ingratitute  ” 
read  “ingratitude.”  On  page  20,  in  twenty-first  line  from  bottom,  for  “pe- 
fore”  read  “  before.”  On  page  21,  in  fifteenth  line  from  top,  for  “is”  read 
“as.”  On  page  26,  in  seventh  line  from  top,  for  “gready”  read  “greedy.” 
On  page  33,  in  fifth  line  from  bottom,  for  “  uteras”  read  “  uterus.”  On  page 
41,  in  fifteenth  line  from  top,  for  “ce”  read  “be”;  and  in  same  line,  for 
“  sntrance”  read  “entrance.” 


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